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Original Investigation
April 18, 2022

Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
  • 2Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
  • 3Section of General Medicine and the National Clinician Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 4Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut
  • 5Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut
  • 6Cancer Outcomes Public Policy and Effectiveness Research Center, Yale Cancer Center, New Haven, Connecticut
  • 7Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 8Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
  • 9Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 10Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 11Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 12Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 13Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2022;182(6):603-611. doi:10.1001/jamainternmed.2022.1022
Key Points

Question  How much do US hospitals mark up the price of parenteral cancer therapies for patients with private health insurance?

Findings  This cross-sectional study examined private payer–specific prices for 25 commonly used parenteral cancer therapies at 61 National Cancer Institute–designated cancer centers. Median price markups across centers ranged from approximately 120% (sipuleucel-T) to 630% (leuprolide) of estimated hospital acquisition costs.

Meaning  The findings of this study suggest that, to reduce the financial burden of cancer treatment for patients, institution of public policies to discourage or prevent excessive hospital price markups on parenteral chemotherapeutics may be beneficial.

Abstract

Importance  The federal Hospital Price Transparency final rule, which became effective in 2021, requires hospitals to publicly disclose payer-specific prices for drugs. However, little is known about hospital markup prices for parenterally administered therapies.

Objective  To assess the extent of price markup by hospitals on parenterally administered cancer therapies and price variation among hospitals and between payers at each hospital.

Design, Setting, and Participants  A cross-sectional analysis was conducted of private payer–specific negotiated prices for the top 25 parenteral (eg, injectable or infusible) cancer therapies by Medicare Part B spending in 2019 using publicly available hospital price transparency files. Sixty-one National Cancer Institute (NCI)–designated cancer centers providing clinical care to adults with cancer were included. The study was conducted from April 1 to October 15, 2021.

Exposures  Estimated hospital acquisition costs for each cancer therapy using participation data from the federal 340B Drug Pricing Program.

Main Outcomes and Measures  The primary outcome was hospital price markup for each cancer therapy in excess of estimated acquisition costs. Secondary outcomes were the extent of across-center price ratios, defined as the ratio between the 90th percentile and 10th percentile median prices across centers, and within-center price ratios, defined as the ratio between the 90th percentile and 10th percentile prices between payers at each center.

Results  Of 61 NCI-designated cancer centers, 27 (44.3%) disclosed private payer–specific prices for at least 1 top-selling cancer therapy as required by federal regulations. Median drug price markups across all centers and payers ranged between 118.4% (sipuleucel-T) and 633.6% (leuprolide). Across-center price ratios ranged between 2.2 (pertuzumab) and 15.8 (leuprolide). Negotiated prices also varied considerably between payers at the same center; median within-center price ratios for cancer therapies ranged from 1.8 (brentuximab) to 2.5 (bevacizumab).

Conclusions and Relevance  Most NCI-designated cancer centers did not publicly disclose payer-specific prices for cancer therapies as required by federal regulation. The findings of this cross-sectional study suggest that, to reduce the financial burden of cancer treatment for patients, institution of public policies to discourage or prevent excessive hospital price markups on parenteral chemotherapeutics might be beneficial.

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