Brown Bagging and White Bagging

“Brown bagging” is a practice by which cancer patients bring their medicine to the clinic for intravenous administration, rather than obtaining the medicine at the clinic.  This is a way for the patient (and perhaps their insurance company) to save money by buying the medicine from a pharmacy rather than from the oncologist or medical clinic.  The supplying wholesaler ships the medicine to the patient’s local pharmacy or to the patient’s home address.  The patient takes the medicine (either in a literal or figurative “brown bag”) to the infusion location (which may be a hospital, a clinic, or a doctor’s office.)  The technicians and nurses at the treatment center check the medicine to ensure it meets requirements and then prepares it for administration.

The Bowl of HygieiaThis practice is related to the idea of “buyers clubs” that patients with expensive treatments sometimes form, and it was motivated by the high cost of chemotherapy medication.  Unlike most medicines, oncology drugs are often sold by the doctors themselves.  The American Society of Clinical Oncology (an industry association of doctors) is, as may be expected, against the concept of brown-bagging.

One concern is that the treatment sometimes needs to be tweaked on the day of the treatment, depending on the patient’s status.  There are also concerns about possible contamination during transit to the patient, or at the patient’s home, and about possible expiration of the medicine.

“White bagging” is tangentially related and when the drug is purchased at a pharmacy that specializes in oncology drugs and shipped directly to the oncology clinic.  Brown bagging, by contrast, involves the pharmacy sending the drug to the patient.  White bagging alleviates some of the concerns about possibility of alterations before the medicine gets to the clinic, but ASCO still opposes it.  Do they oppose it because the practice takes money away from the oncology clinic?  The usual arrangement is for the doctor to receive a drug administration fee.

Both brown bagging and white bagging add some burden to the clinic, who still must deal with storage and safety.

Buyer’s Clubs

The high cost of chemotherapy may push some to seek out Buyers’ Clubs that try to get bulk discounts or share information on less expensive sources.  The idea is that buyer’s clubs can provide patients with details on pharmacies and manufacturers and how trustworthy they are.  The libertarian Goldwater Institute pushed this idea in several state legislatures, calling is “right to try”.  The World Trade Organization rules allow limited imports of medicines for personal use.  The writer at Science Based Medicine thinks buyer’s clubs are a bad idea.  We tried to find chemotherapy Buyers’ Clubs in the US but were unable to do so.  If you know of any, let us know by email: info – at –

Internet Pharmacies

Can you trust organizations you interact with through the internet to give you the medicine you ordered?  Over time, a greater number of patients have taken to buying medicines on-line.  Do your due diligence and see if the business looks reputable.  Your insurance company may have recommendations on which pharmacies to use.  We have not heard of widespread fraud in oncology drugs, but you still need to be careful.