Uninsured patients may be charged anywhere from two to 43 times what private insurance plans or Medicare pay for chemotherapy medications, a new study estimates. Researchers said the findings, reported in Health Affairs, highlight a fundamental inequity.
Stacie Dusetzina, Ph.D., of the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, and colleagues used the new Medicare Provider Utilization and Payment Data Public Use File and other sources to analyze what doctors charged for chemotherapy drugs in 2012.
The authors compared the charges with what Medicare and large private insurers actually paid for those drugs.
On average, the researchers found, Medicare paid only 40 percent of what doctors charged for chemo, while private insurers paid 56 percent.
People without insurance, however, could face whatever the doctor’s office billed them. And those prices would likely stretch far beyond what most could pay, according to the researchers.
For example, the typical charge for the chemo drug oxaliplatin (Eloxatin) was more than $6,700 for one infusion, the researchers found.
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Medicare actually paid around $3,000, while private insurers paid $3,600, on average. Even office visits were pricey for uninsured cancer patients.
They faced charges ranging from $129 to $391. Medicare, meanwhile, paid $65 to $188, and private insurers paid $78 to $246 for the same services.