Private payer‐negotiated prices for FDA‐approved biologic treatments for allergic diseases

Wang, Annette A; Rathi, Vinay K.; Xiao, Roy; Holbrook, Eric H.; Scangas, George A.; Workman, Alan D.; Gray, Stacey T.

doi:10.1002/alr.22922

Cited by 8 publications

(14 citation statements)

References 6 publications

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“…33 Among hospitals disclosing prices within chargemasters, we found wide variation in payer-specific prices both across and within hospitals. These findings are consistent with recent work examining other service lines, including oncology, 14 allergy/immunology, 15 adult otolaryngology, 16 and radiology. 17 Price variation between hospitals may reflect differences in the cost of care delivery due to factors such as patient complexity or differences in operative technique, such as the application of topical anesthesia into the tonsillar fossae or use of the coblation device across hospitals.…”

Section: Discussionsupporting

confidence: 90%

“…Recent work suggests that nearly half of US hospitals are non‐compliant with the Hospital Price Transparency final rule 13 . Among compliant hospitals, analysis of service lines such as oncology, 14 allergy/immunology, 15 adult otolaryngology, 16 and radiology 17 has demonstrated wide variation in prices both across and within hospitals (i.e., by insurance payer). To our knowledge, no prior study has comprehensively examined price transparency for services at pediatric hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

et al. 2022

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Objectives: Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures.Methods: We performed a cross-sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer-specific prices for M&T and T&A. We additionally characterized the extent of variation in payer-specific prices both across and within hospitals.Results: Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across-center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.82 versus 90th percentile: $9,209.88). Median within-center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure. Conclusion:The majority of hospitals serving pediatric patients were non-compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer-specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

et al. 2022

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“…We used descriptive statistics to characterize cancer therapies, disclosure of payer-specific cancer therapy pricing by cancer centers, and variation in disclosed cancer therapy prices. Using previously described methods, [20][21][22][23] we compared payer-specific prices between hospitals by performing a 4-step calculation to determine the across-center ratio for each drug. First, we determined the median price for each drug at each center that disclosed prices.…”

Section: Discussionmentioning

confidence: 99%

“…Using previously described methods, [20][21][22][23] we systematically reviewed each cancer center's website to determine whether the center publicly disclosed private payer-specific prices for items and services within a machine-readable file. 13 For each center with a price transparency file, we then extracted available private payer-specific prices for each cancer therapy in the study cohort; we limited data to prices from plans administered by private payers and excluded prices listed for public payers (eg, Medicare) and international insurance plans.…”

Section: Cancer Therapy Price Extractionmentioning

confidence: 99%

Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance

et al. 2022

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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.OBJECTIVE 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 PARTICIPANTSA 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.EXPOSURES Estimated hospital acquisition costs for each cancer therapy using participation data from the federal 340B Drug Pricing Program. MAIN OUTCOMES AND MEASURESThe 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. RESULTSOf 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.

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“…One year after the Hospital Price Transparency rule was put into effect, only half of the hospitals in our sample disclosed prices for HNSCC therapies. Nondisclosure has been documented in previous studies and is concerning in that it limits a patient's ability to budget for out‐of‐pocket costs of care 17‐19 . A recent analysis by Xiao et al of the top 25 parenterally administered cancer therapies found a price disclosure rate of 44.1%, significant price variation between hospitals, and a large range in price markups over acquisition costs (118%‐633%).…”

Section: Discussionmentioning

confidence: 99%

Private Payer‐Negotiated Rates for FDA‐Approved Head and Neck Cancer Immunotherapy and Chemotherapy Agents

Talwar

Kim

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo quantify the price that private payers pay hospitals for head and neck squamous cell carcinoma (HNSCC) treatments and identify hospital‐level factors associated with price variation.Study DesignCross‐sectional study.SettingPrice transparency files.MethodsFiles from the top 50 hospitals in otolaryngology according to the US News and World Report were analyzed between December 2021 and June 2022. This study analyzed the following Food and Drug Administration‐approved HNSCC therapies: pembrolizumab, nivolumab, cetuximab, cisplatin, carboplatin, and paclitaxel.ResultsTwenty‐four (48%) hospitals reported prices for at least 1 medication in our sample. Newer biologics were significantly more expensive than traditional chemotherapeutic agents. Given approved medication regimens, all biologics in our sample have similar annual costs. Price markups over acquisition costs ranged between 109% (pembrolizumab, nivolumab) and 530% for carboplatin. Across hospitals, prices varied the most for paclitaxel, the cheapest medication in our sample, and prices varied the least for pembrolizumab the most expensive medication in our sample. Hospital 340B status and geographic location in the northeast/west are associated with lower price markups.ConclusionPrice nondisclosure remains a significant problem among hospitals. Newer biological medications are more expensive when compared to traditional chemotherapeutic agents. Prices vary significantly across hospitals, with lower price markups observed in 340B hospitals as well as hospitals located in the geographic northeast and west. It remains to be seen if price transparency will lead to more uniform pricing or lower costs of treatments.

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Private payer‐negotiated prices for FDA‐approved biologic treatments for allergic diseases

Cited by 8 publications

References 6 publications

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance

Private Payer‐Negotiated Rates for FDA‐Approved Head and Neck Cancer Immunotherapy and Chemotherapy Agents

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