Spending by Commercial Insurers on Chemotherapy Based on Site of Care, 2004-2014 | Clinical Pharmacy and Pharmacology | JAMA Oncology | JAMA Network
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Research Letter
April 2018

Spending by Commercial Insurers on Chemotherapy Based on Site of Care, 2004-2014

Author Affiliations
  • 1Department of Clinical Sciences, Pharmacy School, Medical College of Wisconsin, Milwaukee
  • 2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 3University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
  • 4Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
  • 5Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
JAMA Oncol. 2018;4(4):580-581. doi:10.1001/jamaoncol.2017.5544

The impact of price variation because of the site of care—receiving treatment in a physician office vs a hospital outpatient department (HOPD)—is an important driver of health care spending.1 While patients may receive the same treatment in either setting, insurers typically reimburse payments to HOPDs at a higher rate than to physician offices. Hospitals justify this payment difference because they incur higher overhead costs and treat more medically complex patient populations.1,2

Critics argue that the value of the services provided, rather than overhead expenses, should determine prices.2 In this study, we describe trends in use of and spending for infused cancer chemotherapy in HOPD vs physician office settings from 2004 through 2014 among commercially insured patients.