Private payer-negotiated prices for FDA-approved biologic treatments for allergic diseases

摘要

INTRODUCTION: Novel biologic agents have recently emerged as treatments for allergic disease. At present, five monoclonal antibodies (mAbs) have received US Food and Drug Administration (FDA) approval for treatment of allergic diseases, such as asthma and chronic sinusitis with nasal polypo-sis (CRSwNP) (Supplement). However, there are concerns that high prices may limit the cost-effectiveness of mAbs. The cost of mAbs is a function of manufacturer selling prices and subsequent price markups by supply chain intermediaries (e.g., wholesalers) and provider organizations (i.e., physician offices or hospital outpatient departments) that ultimately administer the drugs. While high manufacturer sales prices for mAbs have received much attention, less is known about the extent to which provider organizations may inflate mAb prices. Provider organizations and insurance companies have historically considered negotiated prices for drugs to be proprietary information. Recent analysis of deidentified commercial insurer claims suggests that prices for biologics are approximately 70% greater at hospitals than at physician offices. On January 1, 2021, the Centers of Medicare and Med-icaid Services (CMS) implemented the Hospital Price Transparency final rule, which required hospitals to publish payer-negotiated prices for all items and services online. We analyzed newly available price data disclosed in compliance with this law to investigate the extent of hospital price markup for mAbs and of price variation among hospitals and within hospitals between payers.