After multiple years of mandated disclosure of negotiated hospital-insurer rates, those of us who follow the buy-and-bill channel might have expected transparency to reduce drug price variability, lower hospital markups, and accelerate adoption of lower-cost biosimilars.
Alas, that’s not what the latest data reveal.
DCI’s analysis of four national commercial insurers—Aetna, Anthem, Cigna, and UnitedHealthcare—and 26 hospitals found that:
- Hospitals still earn significant markups over average sale price (ASP). 340B hospitals earn even more.
- Insurers pay wildly varying amounts for the same drug.
- Some hospitals get paid significantly more than others for the same drug.
- Insurers can pay more for a lower-cost biosimilar than for the higher-cost reference product.
While provider-administered biosimilars are significantly cheaper than their reference products, hospitals and insurers are still making them expensive for plan sponsors. Meanwhile, patients with coinsurance and deductibles are paying higher out-of-pocket costs.
Transparency was supposed to clean things up—but someone forgot to bring the mop.
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