Insurers Take Up Fight Against Rising Chemotherapy Costs, by Julie Appleby, Kaiser Health News
Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.
Patients say, ‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 — and I was in the same room with the same doctor same nurse and the same length of time,’ said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania.
Like other insurers, Highmark found that when hospital systems bought doctors’ practices, chemotherapy costs rose because physicians’ offices were then deemed ‘hospital outpatient centers’ and could charge more for overhead.
Now insurers are pushing back. In what may be the first move of its kind, Highmark in April stopped paying higher fees for chemotherapy drugs given to patients whose doctors work for hospitals, instead paying the same price they would have had the doctor remained independent. . . .