At a Glance | January 30, 2020 Payments for Infused Cancer Medicines Are Nearly Two Times Higher in Hospital Outpatient Departments Than Physician Offices Based on 18,195 users of the top 37 infused cancer drugs prescribed to employment-based and commercially insured patients in 2016. CANCER MEDICINES NEARLY TWO TIMES HIGHER On a drug-by-drug basis, Top 37 cancer drugs In 2016, hospital prices for the top hospital outpatient averaged 37 infused cancer drugs averaged departments charge 86.2 percent more per unit than in physician offices. Differences in 86.2% 1.3x to 4.3x prices ranged from 128.3 percent more per unit in hospitals to 428 percent. These cost more than physician offices than in physician offices. differences were due to pricing for cancer medicines. decisions of hospitals, not differences in modality. AVERAGE REIMBURSEMENT Average Annual Reimbursement per Cancer Patient RATE NEARLY $9,000 MORE $21,881 The average reimbursement to providers per cancer patient was $13,128 in physician offices and $13,128 $21,881 in hospital outpatient $8,753 departments, a difference of $8,753. That means on average, hospitals were reimbursed $8,753 more for each patient. Hospital Outpatient Physician Offices Facilities EMPLOYERS & INSURERS COULD SAVE NEARLY $10,000 PER PATIENT Nearly half of the cancer patients 51% in the study were treated in Physician hospital outpatient departments. If Office payers reimbursed hospitals at the Cancer same rate they reimbursed Patient physician offices, the average Treatment payment per cancer patient would 49% Site have dropped by 45 percent. That Hospital means over one year, employers Outpatient Department and insurers could save $9,766 per covered cancer patient without affecting quality of care. SOURCE: Paul Fronstin, M. Christopher Roebuck, and Bruce C. Stuart, “Cost Differences for Oncology Medicines Based on Site of Treatment,” EBRI Issue Brief, no. 498 (Employee Benefit Research Institute, January 16, 2020). © 2020 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org.