该分析涵盖1,700多家医院、8种学名癌症药与多家大型保险公司；其中约40%的医疗中心，至少对一家保险公司收取了≥5倍 Medicare 的费用。随著过去15年学名药竞争增加，Medicare 支付价格明显下降；专家指出民间保险通常只比 Medicare 高出少数倍，而不是资料中看到的5倍、10倍，或在个案中超过350倍。Turquoise Health 还会排除高于 Medicare 10倍以上的商业费率，因此极端值可能被低估。
案例中，Unite Here Health 覆盖约23万名会员、每年医疗支出约13亿美元，估算单是化疗药物加价就让每位会员每月成本增加近10美元；即使患者只看到固定自付额，成本仍会透过保费与共付额回流。某些输注每次可让计划多付逾13,000美元；另有一名68岁多发性骨髓瘤患者，某学名药硼替佐米（bortezomib）费用接近 Medicare 的7倍，且他一年仍自付约4,000美元。虽有价格透明化规定，但资料难用、合规不一，加上部分市场供应者集中，使降价像打地鼠一样反复出现。
A decades-old generic chemotherapy drug, oxaliplatin, can cost Medicare about $35 for a given dose, yet hospitals can bill far more for the same infusion. A Bloomberg analysis of Turquoise Health data found nearly 150 US hospitals charging at least one insurer five times Medicare’s rate or more; in some cases, the markup reaches hundreds of times.
The review covered 1,700+ hospitals, eight generic cancer drugs, and multiple major insurers; about 40% of centers charged at least one insurer ≥5× Medicare for at least one of the drugs. Medicare rates have fallen over ~15 years as generics spread, and experts say private payers are usually only a few times Medicare—not 5×, 10×, or (in one case) >350×. Turquoise Health also excludes commercial rates >10× Medicare, so extreme overpricing is likely understated.
For Unite Here Health, which covers ~230,000 people and spends about $1.3B annually, chemotherapy drug markups increased per-member costs by almost $10 per month. Patients may see only a copay, but the plan can pay >$13,000 extra per infusion; one worker earned about $27/hour, making the difference roughly three months’ wages. Another patient with multiple myeloma faced nearly 7× Medicare pricing for generic bortezomib and owed about $4,000 in uncovered costs. Transparency rules exist, but uneven compliance, messy data, and provider market power keep prices high and shifting.
