Employer health plans paid hospital outpatient departments an average of 102% more per unit than physician offices for the same injected and infused medications, according to new research from the Employee Benefit Research Institute(EBRI). These drugs are given by clinicians in a medical setting and include treatments for cancer, autoimmune diseases, and other serious chronic conditions.
EBRI estimates that paying hospital clinics at office rates would save employer plans about $12.7 billion a year, or roughly $101 per covered member. That estimate extends the findings to all physician-administered outpatient drugs; the 106 drugs studied directly accounted for about $9.8 billion of the difference, Fierce Healthcare reported. The issue brief, by Paul Fronstin and M. Christopher Roebuck, was published September 24 and draws on commercial claims from 2023 and 2024.
