Private insurers, cash-paying patients pay much more than Medicare for hospital drugs

Private insurers and cash-paying patients face prices several times higher than the Medicare rate for clinician-administered drugs, according to a study published Nov. 8 in JAMA Internal Medicine.

Researchers searched the websites of the 20 top-rated hospitals by U.S. News & World Report for drug pricing files between Jan. 1 and Sept. 15, extracting private insurer-negotiated prices and self-pay cash prices for the 10 drugs with the highest 2019 Medicare Part B expenditures. 

Median prices for the 10 drugs surpassed the Medicare payment limit by a low of 169 percent at Rush University Medical Center in Chicago and a high of 344 percent at Mayo Clinic Hospital in Phoenix. Median prices for self-pay patients ranged from 149 percent of the Medicare payment limit at Rush to 306 percent at Brigham and Women's Hospital and Massachusetts General Hospital, both in Boston.

The report found "substantial" price variation by drug, with abatacept having the lowest median negotiated prices relative to the Medicare payment limit and infliximab having the highest. Both drugs treat autoimmune conditions.

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