The Effect of Insurance Type on Cancer Drug Prices

Cancer patients without insurance can be paying up to 43 times what Medicare pays for the same chemotherapy drugs, according to a new study published in Health Affairs from the University of North Carolina at Chapel Hill.

Cancer patients without insurance can be paying up to 43 times what Medicare pays for the same chemotherapy drugs, according to a new study published in Health Affairs from the University of North Carolina (UNC) at Chapel Hill.

The researchers reviewed data from the Medicare Provider Utilization and Payment Data Public Use File on physician charges, reimbursements by Medicare and large private health plans, and expected patient cost sharing for outpatient oncology care. They found that in 2012 Medicare reimbursed 39.6% of charges for chemotherapy and private insurance reimbursed 55.7%.

According to Dr Dusetzina, because North Carolina did not expand Medicaid, there is a large population that is not eligible for subsidies because the law assumed these patients would be covered by Medicaid. As a result, they cannot afford to purchase health insurance on the exchanges without these subsidies and will remain uninsured.

Overall, uninsured patients faced chemotherapy prices that were between 2 and 43 times as much as Medicare and between 2 and 5 times as much as private insurance.

“Patients with Medicare and private insurance don’t pay the sticker price of health care,” Stacie Dusetzina, PhD, lead author and an assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health at UNC, said in a statement. “They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”

If uninsured patients did not negotiate their bills, they could pay $6711 for an infusion of oxaliplatin for colorectal cancer, while Medicare paid $3090 and private health plans paid $3616 for the same treatment, according to the researchers.

The prices of a doctor visit also varied widely depending on insurance coverage. Depending on the complexity of the visit, uninsured individuals could expect to be billed between $129 and $391 for a visit compared with the $65-$188 that Medicare paid and the $78-$246 private insurance paid for the same visit.

“This is unreasonable,” she said. “There needs to be more transparency and less variability in healthcare pricing.”