LUGPA Policy Update: Wide Disparities in Hospital Drug Prices

March 2026

At-a-Glance Essentials

What’s Happening:
A new analysis of hospital pricing data shows dramatic variation in the prices hospitals charge for the same high-cost prescription drugs, sometimes differing by tens of thousands of dollars for a single dose.

Why It Matters:
Despite federal price transparency rules, pricing for physician-administered drugs remains inconsistent and difficult to compare, contributing to higher healthcare costs and limited market competition.

Impact on Urology Practices:
Several drugs used to treat urologic cancers show wide price variation in hospital settings, reinforcing ongoing concerns about site-of-service payment disparities.

Key Takeaway:
The findings highlight the need for stronger transparency enforcement and policies that promote fair competition between hospital outpatient departments and independent physician practices.

Significant Variations in Hospital Drug Pricing

A March 2026 analysis by consulting firm 3 Axis Advisors, prepared for the nonprofit Patient Rights Advocate, examined more than 1,300 hospital chargemaster files published under federal price transparency requirements. The study found substantial differences in the prices hospitals report for the same physician-administered drugs.

For example, the reported price for a single 200 mg dose of Keytruda (pembrolizumab) ranged from roughly $12,000 to more than $43,000, while Opdivo (nivolumab) ranged from approximately $17,000 to $67,000 per dose. Similar variation appeared across several specialty medications commonly administered in hospital outpatient settings.

Even within the same hospital system, pricing often varied significantly depending on the insurer involved, reflecting the complexity of negotiated contracts between hospitals and health plans.

Transparency Challenges Remain

The analysis also highlighted continuing challenges with hospital price transparency compliance. While most hospitals now publish machine-readable files as required under federal rules, the usefulness of those files varies widely.

The researchers found that although about 93% of hospitals posted pricing files, only around 62% contained usable pricing information for key high-cost drugs. Inconsistent reporting formats, unclear coding, and incomplete data make it difficult for patients, employers, and policymakers to compare prices across hospitals.

These transparency gaps limit consumers' and purchasers' ability to identify lower-cost care options and reduce the competitive pressure that transparency rules were intended to create.

Why This Matters for Urology

Many of the medications highlighted in the report, including immunotherapies used to treat bladder and kidney cancers, are also administered in urology and oncology settings. Hospitals often receive higher reimbursement for administering these drugs than physician offices, contributing to longstanding site-of-service payment disparities.

Independent physician practices frequently deliver these treatments at lower overall cost, yet hospital contracting structures and facility fee arrangements can steer patients toward higher-priced hospital outpatient departments.

For patients receiving specialty cancer therapies, these pricing differences can translate into significantly higher out-of-pocket costs depending on where treatment occurs.

LUGPA Perspective

The findings reinforce longstanding concerns about price variation and payment differences across healthcare settings. As policymakers continue evaluating healthcare affordability and transparency policies, ensuring consistent pricing data and fair reimbursement across sites of care will remain critical.

LUGPA continues to support policies that strengthen hospital price transparency requirements, improve reporting standards for hospital-administered drugs, and advance site-neutral payment reforms that allow independent physician practices to compete on a level playing field while maintaining patient access to high-quality, cost-effective care.