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

Abstract

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.

Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer‐Reviewed Literature

“…Of the 44 included studies, all were observational studies, and none were experiments; 18 were single-site case studies, 38,39,41,42,45,46,[49][50][51]56,[59][60][61][62][63][70][71][72] 1 was a single-site observational study (comparing patients receiving 340B discounts with those on patient assistance programs [PAPs] for medication affordability), 47 17 were multisite descriptive studies, 40,43,44,[53][54][55]57,58,[64][65][66]68,73,74,76,77,79 1 study assessed the feasibility of a quasi-experimental identification strategy, 69 and 7 were quasi experiments. 30,31,48,52,67,75,78 We grouped the studies by suitability of study design for internal validity, as defined above.…”

“…Twelve 340B studies had at least one outcome that related to payer spending and clinic budgeting. 30,40,45,52,59,60,64,68,73,[77][78][79] We grouped these outcomes as responding to three general research questions: i) Does drug spending and use differ by 340B status? ii) What is the price of drugs offered to patients at 340B-covered entities-do covered entities pass along 340B discounts to patients?…”

“…Three studies examined the price of drugs at 340B-participating hospitals. [77][78][79] Two studies (both moderate suitability) used price transparency files to examine the price of cancer medications at 340B hospitals. 77,79 Both studies found evidence of large price markups for cancer drugs (ranging from 109% to 633% of acquisition), 77,79 but one of the studies found that 340B hospitals had a 29% lower price markup than hospitals that did not qualify for the program.…”

“…[77][78][79] Two studies (both moderate suitability) used price transparency files to examine the price of cancer medications at 340B hospitals. 77,79 Both studies found evidence of large price markups for cancer drugs (ranging from 109% to 633% of acquisition), 77,79 but one of the studies found that 340B hospitals had a 29% lower price markup than hospitals that did not qualify for the program. 79 The first study only examined 340B-particpating hospitals (i.e., 61 National Cancer Institutedesignated cancer centers; cancer hospitals are automatically eligible for 340B); the second study examined 340B and non-340B hospitals (i.e., top 50 US otolaryngology hospitals).…”

“…77,79 Both studies found evidence of large price markups for cancer drugs (ranging from 109% to 633% of acquisition), 77,79 but one of the studies found that 340B hospitals had a 29% lower price markup than hospitals that did not qualify for the program. 79 The first study only examined 340B-particpating hospitals (i.e., 61 National Cancer Institutedesignated cancer centers; cancer hospitals are automatically eligible for 340B); the second study examined 340B and non-340B hospitals (i.e., top 50 US otolaryngology hospitals). A third study (greatest suitability) found that CAHs' charges per Part B outpatient drugs decreased after 2010's 340B expansion, concluding that CAHs seem to pass along 340B discounts to patients, which the authors attributed to CAHs' costbased reimbursement.…”