Study: Cancer drug prices vary widely depending on who’s paying

Patients without insurance could be asked to pay twice as much or more than insurers pay for chemotherapy, according to a study published in he April issue of Health Affairs.

Charges for health services-the amounts providers request before payments are negotiated-have not been widely known for services delivered in physicians’ offices. Charges can be considered the maximum amount that would be paid by a person without insurance who does not or is unable to negotiate for a lower price.

DusetzinaIn the study, lead researcher Stacie Dusetzina, an assistant professor at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health, and colleagues used recently released data from the Medicare Provider Utilization and Payment Public Use File and other sources to measure what physicians charged for chemotherapy drugs delivered intravenously in 2012 and the amounts reimbursed by Medicare and private health plans for the same services.

Dusetzina and her colleagues found that uninsured cancer patients may be asked to pay from 2 to 43 times what Medicare pays for chemotherapy drugs, according to Dusetzina.

“Medicare and insurers don’t pay the sticker price of healthcare,” she said. “They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”

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On average, Medicare paid approximately 40% of the charged amounts for chemotherapy drugs. Private insurers paid nearly 57% of the charged amounts on average.

 

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