New Report Reveals Major Variation in Hospital Pricing of Cancer Drugs

In today’s rapidly evolving cancer treatment landscape, the integration of novel medicines into treatment regimens is complicated by high costs and concerns about financial toxicity. A new report analyzing hospital drug pricing in the US reveals extreme and inconsistent pricing for high-cost prescription drugs, underscoring the need for broader structural reform to improve transparency and accountability in pricing practices.¹

The analysis, conducted by research firm 3 Axis Advisors, highlights a systemic lack of standardization in how hospitals charge for physician-administered treatments, particularly in the oncology sector where specialty drugs and biologics represent a significant portion of healthcare expenditures.

The study found that negotiated rates for the same medication varying by more than 2000-fold across different facilities and insurance plans. In practice, this means that while one hospital might charge a nominal amount for a specific treatment, another hospital could charge over 2000 times that amount. These disparities were particularly pronounced among 5 high-volume medications analyzed in the report, including several primary oncology agents.

“As policymakers look for affordability solutions in health care, this analysis highlights a persistent problem in the system: hospital drug pricing remains opaque, inconsistent, and difficult to evaluate,” said Ted Okon, executive director of the Community Oncology Alliance, in a news release.² “Patients with cancer can face dramatically different costs for the same treatment depending on where it is delivered, yet the underlying pricing practices of hospitals remain impossible to evaluate.”

Pricing Disparities Across Key Oncology Drugs

Specifically, the report examined negotiated rates for pembrolizumab (Keytruda), a PD-1 inhibitor widely used across various solid tumors following pivotal trials such as KEYNOTE-189 (NCT02578680). Negotiated prices for a 200-mg dose of pembrolizumab ranged from approximately $12,000 to $43,000. Similarly, nivolumab (Opdivo), another PD-1 inhibitor established through trials like CheckMate 067 (NCT01844505), saw negotiated rates for a 480-mg dose ranging from $17,000 to as high as $67,000.

The variation also extended to subcutaneous formulations. The targeted myeloma therapy daratumumab and hyaluronidase-fihj (Darzalex Faspro), which demonstrated noninferiority to intravenous administration in the phase 3 COLUMBA trial (NCT03277105), showed pricing variation for an 1800-mg dose ranging from $9,300 to $36,000.

Furthermore, the analysis revealed that hospital negotiated rates often vastly exceed standard reimbursement benchmarks. In the majority of cases studied, negotiated prices were significantly higher than the Medicare Average Sales Price (ASP) plus 6%—the typical payment rate for Medicare Part B drugs. The report suggests that hospitals often yield profit margins on these drugs that exceed those of the manufacturers themselves.

Notably, the study authors believe their findings may underestimate hospital markups, as the analysis used ASP + 6% as a conservative estimate of acquisition cost and did not factor in 340B program discounts, which can further lower a hospital’s actual cost for these agents.

Compliance Without Clarity: Data Quality Concerns

Despite federal mandates requiring hospitals to publish their negotiated rates, the lack of transparency in the actual cost of care persists. Authors highlighted a persistent gap between "in-form" and "in-spirit" hospital compliance with the federal Hospital Price Transparency Rule, where in-form compliance refers to hospitals meeting the minimum posting requirements, while in-spirit compliance involves providing complete, accurate, and usable pricing data. While 93% of the analyzed hospital files adhered to the formatting required by the Centers for Medicare & Medicaid Services (CMS), only 62% of those files contained usable pricing data for common, high-cost medications.

The incompleteness and inconsistency of the data hinder the ability of patients, providers, and patients to assess the potential financial toxicity associated with specific sites of care, giving rise to an overall financial burden for the healthcare system.

“The toxicity, from a financial standpoint, hits every angle, from the patient to the system at large, to payers, and to the providers as well,” said Lucio Gordan, MD, Florida Cancer Specialists & Research Institute, in a recent interview with Targeted Oncology when describing how financial toxicity manifests in practice. Gordan emphasized how community oncology can often be a more cost-efficient setting than hospitals for delivering complex cancer care, highlighting the crucial role of transparent, actionable information to empower patients and providers in making informed treatment decisions.

“We have shown that our site of care, away from expensive venues like hospital systems, hospital clinics, and ED [emergency department] visits, is an important way to control cost,” he added. “We calculated that we can save billions on a yearly basis for the system, patients, payers, and country by simply shifting the site of care to community oncology.”

Toward Meaningful Transparency: A Call for Reform

The data points unearthed in the report are critical when considering the total cost of care. The extreme variation suggests that traditional assumptions regarding insurance "discounts" may be flawed; in several instances, the cash price offered to uninsured patients was lower than the negotiated rate for certain commercial insurance plans.

The report concludes that while federal transparency mandates have provided a window into hospital pricing, the data remain too nonstandardized and complex for meaningful consumer or clinical utility. As such, the authors of the report call for greater structural reform, including stronger CMS oversight and enforcement of data quality standards and integration with consumer-oriented tools to allow patients, clinicians, and payers to more thoroughly compare drug prices across care facilities.

Without standardization and rigorous enforcement of data quality, the systemic price opacity and variability in hospital drug pricing is likely to persist, complicating efforts to achieve affordability in oncology care.

REFERENCES

1. Analysis of prescription drug prices in hospitals. 3 Axis Advisors. March 5, 2026. Accessed March 12, 2026. https://tinyurl.com/4prm3wyh

2. Community Oncology Alliance calls for greater federal action and greater transparency in hospital drug pricing following new analysis. News release. Community Oncology Alliance. March 9, 2026. Accessed March 12, 2026. https://tinyurl.com/3kx3wz9d