This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute.
Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance
Analysis of 61 NCI-designated cancers demonstrate parenteral cancer drug price markups across all centers ranging between 188.4% to 633.6%. Only 27 centers publicly disclose payer-specific prices for cancer therapies as required by federal regulation. Authors recommend public policies to discourage excessive hospital price markups on patenteral chemotherapeutics to reduce financial burden on cancer treatment for patients.
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.
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.
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.
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.
Author Affiliations1Department 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
Compliance of National Cancer Institute–Designated Cancer Centers With January 2021 Price Transparency Requirements
While price transparency across sites of care on its face is a step in the right direction, datapoints when viewed discretely are less informative when it comes to the actual costs associated with cancer care. Additional work, analysis and research is much needed across the stakeholder continuum to fully understand the costs associated with the treatment of cancer, and to further achieve the transparency goals set forth by CMS in 2019 with this initiative.
STAT News published the below Op Ed from COA that does that highlights the dysfunction of the 340B system and how Hospital Systems and PBMs are profiting Billions of dollars a year off of a program that was intended to help underserved patients. Is a great “high level” review to help understand the overall impact on the US medical system and the importance of health care reform in this area.
Here we see a review of literature assessing the impact of patient assistance programs on outcomes broadly in cancer care. While indirect links may be drawn between the prevalence of financial toxicities and outcomes, adherence, etc., additional research studies are needed to more clearly demonstrate the tangible impact of these programs to support future investments from stakeholders.
Thought-provoking oped highlighting the underbelly of buzzwords in healthcare today. The shift from volume to value that we’ve seen unfold over the past 3-5 years has moved front and center in many conversations, yet remains elusive insofar as its definition and implementation. This article rightly calls out that value is ultimately in the eye of the beholder, and yet there’s no disputing that doing what’s right for the patient trumps all.