Uninsured Patients Pay Much Higher Cost for Cancer Drugs

Private insurers and Medicare patients can pay up to 43 times less than the uninsured.

The cost of cancer drugs can wildly fluctuate based on the insurance status of a patient, according to a new study from the University of North Carolina at Chapel Hill.

The researchers found that uninsured cancer patients can pay anywhere from 2 to 43 times more than what patients on Medicare pay for chemotherapy drugs. The study included recently released Medicare data on the price patients are charged by physicians for chemotherapy drugs delivered intravenously in 2012.

The study estimated that uninsured patients who failed to negotiate the amount they were billed for paid $6711 for an infusion of colorectal cancer drug oxaliplatin, while patients with Medicare or private health plans paid just $3090 and $3616, respectively, for the same therapy.

While uninsured patients on average paid twice what patients with Medicare paid for chemotherapy drugs, there were also significant payment differences found for drugs that were inexpensive on Medicare. Carboplatin, for example, had an estimated cost of $26 for an infusion with Medicare, while the estimate for uninsured patients was $1124.

The study authors noted that the escalating cost of specialty drugs is of vital importance to millions of zero and low-income earners who pay the full cost for prescription drugs, while lacking affordable options for coverage or federal subsidies.

"Patients with Medicare and private insurance don't pay the sticker price of health care," lead researcher Stacie Dusetzina, an assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health, said in a press release. "They pay a discounted rate. However, uninsured patients don't have the bargaining power, or they may not try to negotiate for a better price."

The study also analyzed the cost of a doctor visit for cancer patients. Researchers found that uninsured patients were billed between $129 and $391 dependent on the complexity of the visit.

Meanwhile, patients with Medicare paid between $65 and $188 per visit and patients with private insurance paid between $78 and $246 per visit.

"This is unreasonable," Dusetzina said. "There needs to be more transparency and less variability in health care pricing."

Despite the Affordable Care Act mandate that US citizens must be insured or pay a tax penalty, a high number of people are still uninsured, which emphasizes the importance of the cost of care for these patients.

"In states like North Carolina that didn't expand Medicaid, there is a large group of people who can get insurance on the federal exchange but cannot get subsidies because the law assumed they would be covered by Medicaid," Dusetzina noted.