Consumers cheered when the Hospital Price Transparency rule took effect in January 2021, requiring that facilities publish their payer-specific negotiated rates for drugs and services. Despite the positive news, there remains a blatant lack of compliance that continues to keep patients in the dark.
Everyone deserves a less costly, more compassionate health plan, especially those being treated for cancer. To follow up on how well the new rule was driving transparency, JAMA Internal Medicine conducted a study of private-payer prices for 25 commonly used cancer therapies at 61 cancer treatment centers so designated by the National Cancer Institute.
In its review of the JAMA study, Cancer Therapy Advisor summarizes the results by saying, “A majority of National Cancer Institute (NCI)-designated cancer centers violated federal law last year by failing to disclose payer-specific prices for cancer therapies.” By year-end, only 44% had disclosed private-payer prices for at least 1 of the 25 top-selling therapies. The remaining 56% remained utterly opaque and in defiance of the rule.
The JAMA study further estimated the acquisition costs for each of the 25 therapies and the extent to which they were marked up by the hospitals administering them. Median markups across all centers and payers ranged between 118% to a whopping 634%. Negotiated prices also varied considerably between payers at the same center.
JAMA concludes by stating, “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.”
It’s important to ensure that employer health plan sponsors pay fair prices not only for medical services and retail pharmacy drugs, but also for all drug claims on the medical plan, like those used for cancer treatment.
Advisors and employer health plan sponsors are best served by health plan administrators like Vitori Health that incorporate reimbursement controls for drugs delivered in facility care settings. This can have a significant impact in reducing overspending for employers and patients going through difficult life and death treatments.