The Impact of Site-Neutral Payment on Healthcare Costs, Patient Access | AMCP Annual 2025

Connie Estep, Pharm.D., BCGP, director of specialty clinical solutions at Prime Therapeutics, caught up with Managed Healthcare Executive editors to discuss the effects of site-neutral payment, which was a session she presented at the AMCP 2025 meeting in Houston.

The session titled “Legislative Impacts on Site of Service: What is the Big Deal?” was presented by Estep on Tuesday. AMCP 2025 runs from March 31 to April 3.

Estep explained that site-neutral payment aims to integrate reimbursement rates across all healthcare settings in efforts to eliminate the disparities between hospital outpatient facilities, specialty pharmacies and home infusion providers.

“Instead of a hospital outpatient facility billing a higher dollar amount than a specialty pharmacy or a home infusion provider, all of these would fall under one single fee schedule that is specific to each drug product but universal across all sites of service,” Estep explained.

Currently, lawmakers are considering site-neutral payment as a cost-saving tool, particularly within Medicare.

Estep shared there are studies that suggest that implementing site-neutral payment could save up to $105 billion over ten years.

The current system allows hospital outpatient facilities to charge significantly higher rates than other sites, leading to large markups for infusions, she said.

“Lawmakers are very interested in site-neutral payments because this is a good opportunity to reduce costs,” Estep added.

While this reform could lower healthcare costs, hospitals that benefit financially under the current system are pushing back against it.

Many outpatient facilities that currently receive large markups strongly oppose the change, fearing financial losses.

If implemented, site-neutral payment could benefit both patients and payers.

Estep explained that patients often pay a percentage of their medication costs, so lower drug prices at outpatient settings would result to reduced out-of-pocket expenses.

In addition, health plans could reinvest these savings into expanded benefits.

“This is a really good opportunity to benefit patients, to really ensure that we're still allowing them their freedom of choice but also doing our duty to be fiscally responsible,” Estep said.

Despite potential pushback from hospitals, site-neutral payment could play a crucial role in making healthcare more affordable and accessible.