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, according to a study published in JAMA Internal Medicine.
The Hospital Price Transparency final rule, which took effect in 2021, requires public disclosure of payer-specific prices for services and drugs.
Researchers found that, between April 1, 2021, and October 15, 2021, only 44% of NCI-designated cancer centers disclosed private payer-specific prices for at least 1 top-selling cancer therapy.
The researchers also observed substantial price markups above acquisition cost. The median price markup was as high as 633.6% for 1 drug.
This study included 61 NCI-designated cancer centers. The researchers evaluated the private payer-specific negotiated prices for the top 25 parenteral cancer therapies (according to Medicare Part B spending in 2019).
Of the 25 therapies, 68.0% were biologics, 28.0% were small molecules, and 4.0% were “other” therapies. Most (64.0%) did not have an approved generic or biosimilar formulation available and had been approved as an orphan drug for at least 1 indication (80.0%).
Results: Disclosure, Markup, Variability
Most of the cancer centers violated the Hospital Price Transparency final rule. Only 27 of the 61 centers (44.3%) disclosed the payer-specific prices for at least 1 of the parenteral therapies.
When the researchers looked at hospital price markup above acquisition cost, they observed wide variations by drug. The lowest markup was for sipuleucel-T, at 118.4%, and the highest markup was for leuprolide, at 633.6%.
The researchers also looked at differences in prices across the cancer centers and found the median across-center price ratio was 3.1 for all drugs, ranging from 2.2 for pertuzumab to 15.8 for leuprolide.
In addition, different private payers had negotiated different prices for the same drug at the same centers. The median within-center price ratio ranged from 1.8 for brentuximab vedotin to 2.5 for bevacizumab.
According to the researchers, these findings 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.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Xiao R, Ross JS, Gross CP, et al. Hospital-administered cancer therapy prices for patients with private health insurance. JAMA Int Med. Published online April 18, 2022. doi: 10.1001/jamainternmed.2022.1022