The federal Medicare program and private health insurers waste nearly $3 billion annually buying oversized single dose vials of cancer drugs, according to a study published March 1 in BMJ, formerly known as the British Medical Journal.
The expensive cancer drugs come in single dose packages based on a patient's weight or body size. However, they must be either administered or discarded once open, and because patients' body sizes are unlikely to match the amount of drug included in the vial, there is nearly always some left over, according to researchers at New York City-based Memorial Sloan Kettering Cancer Center, who published the study. All the drug in the vial still must be paid for, even when discarded, meaning drug companies are able to artificially increase the amount of drug they sell per treated patient by increasing the amount in each single dose vial relative to the typically required dose, researchers said.
Researchers noted physicians and hospitals also profit because they buy single dose vials of drugs and then bill insurers or patients when they are used. The bill includes a percentage-based markup which can vary widely.
So researchers looked at spending on cancer drugs that are packaged in single dose vials and dosed based on body size in the U.S. to estimate the extent of the problem. They analyzed the waste generated by the top 20 selling cancer medicines and found insurers paid drug makers $1.8 billion annually on discarded quantities and then spent about $1 billion on markups to physicians and hospitals, according to The New York Times.
Researchers also found the extent and cost of leftover drugs varies according to market size and available vial sizes. For example, in 2016, 7 percent of $3.9 billion in rituximab sales will be discarded, totaling $254 million, while 33 percent of $697 million in carfilzomib sales will be discarded, totaling nearly $231 million.
In light of their findings, researchers urged policy makers to look at approaches that would reduce or eliminate paying for leftover drugs. They said manufacturers should be required to package drugs in quantities that allow better matching with required doses or enable virtual return of leftovers. As an alternative, regulators could also let manufacturers pick their vial sizes but also require them to refund the cost of leftover drug, researchers said.
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