Hospitals, on average, charge double the price for the same drugs sold by specialty pharmacies, according to research from America's Health Insurance Plans.
Upon analyzing the 10 drugs that amounted to the highest Medicare Part B spend from 2018-2020—and were purchased, stored and administered in a healthcare setting—an AHIP study published Wednesday found that drug treatments given in hospitals were marked up an average of $7,000, when compared to those purchased through specialty pharmacies.
As these drugs typically do not have biosimilars or generics that provide cost competition, specialty pharmacies are responding to a crucial market need to lower drug prices, said Sergio Santiviago, vice president of drug policy at AHIP.
Although the higher prices aren't a result of hospitals "trying to game the system," Santiviago said specialty pharmacies can save money per claim and per dose, allowing insurers to focus on paying the physician for the service of administering the drug, rather than the cost of the drug itself.
"We're able to use these specialty pharmacies in these logistical advancements to really stretch that dollar and provide more access to these drugs at a lower cost without sacrificing safety or quality of care," Santiviago said.