Uninsured may face much higher charges for cancer drugs

Doctors may charge uninsured patients anywhere from two to 43 times what private insurance plans or Medicare pay for chemotherapy drugs, a new study estimates.
Researchers said the findings, reported in the April issue of Health Affairs, highlight a fundamental inequity.

“It seems that uninsured patients should not be charged more than an insurance company would pay for the same services,” said lead researcher Stacie Dusetzina, an assistant professor at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health.


It’s no surprise, she said, that uninsured patients may be charged more than the negotiated, discounted rates paid by insurance companies and Medicare — the federal health insurance program for older Americans.


“What was surprising was the magnitude of the difference,” Dusetzina said.


Most of the charges for chemo drugs were double what insurers paid, she said. But charges for some drugs were up to 43 times what Medicare paid, and five times what private insurers paid.


“Obviously, it would be extremely challenging for most people to even attempt to pay the prices set for infused chemotherapy that we see here,” Dusetzina said.


And while the Affordable Care Act — also known as “Obamacare” — made it mandatory for Americans to have health insurance or pay a penalty, many people remain uninsured, Dusetzina noted.


She pointed, in particular, to states that chose not to expand Medicaid, the government health insurance program for the poor. That has left some lower-income Americans in a quandary: They do not qualify for Medicaid, and they can’t afford the premiums on private health plans.


Studies have already shown that US hospitals typically charge much more for a range of services than hospitals in other countries — and also that within the United States, charges can vary hugely from one hospital to another.


But until recently, researchers have had little access to data on individual doctors’ charges.


Last year, however, Medicare and Medicaid began releasing that information for public use.


Dusetzina’s team took advantage of that. Using the government data, the researchers looked at what doctors charged for chemotherapy drugs in 2012.

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