| Company | Brand | Treatment | Amount Less Kaiser Pays Compared with United Healthcare |
|---|---|---|---|
| Alnylam Pharmaceuticals | Oxlumo | Lumasiran injection | 198.94% |
| Bayer | Eylea | Aflibercept injection | 189.29% |
| Stemline Theraputics | Elzonris | Tagraxofusp injection | 195.58% |
| Horizon Therapeutics | Krystexxa | Pegloticase injection | 153.19% |
| Novartis | Lucentis | Ranibizumab injection | 194.25% |
| Novartis | Ilaris | Canakinumab injection | 197.09% |
| Novartis | Signifor | Pasireotide injection | 186.62% |
| Shire Pharmaceuticals | Oncaspar | Pegaspargase injection | -132.49% |
| Sun Pharma | Ilumya | Tildrakizumab injection | 196.27% |
| Ipsen | Somatuline | Lanreotide injection | 197.94% |
Here’s the data in more detail:
| NDC Code | Treatment | Kaiser Permanente | United Healthcare (Min) | United Healthcare (Max) | Brand | Company | |
|---|---|---|---|---|---|---|---|
| 71336-1002-01 | Lumasiran injection | $296.83 | $111487.20 | "$119 | 644.80" | Oxlumo | Alnylam Pharmaceuticals |
| 61755-0005-02 | Aflibercept injection | $915.75 | $33300.00 | "$43 | 068.00" | Eylea | Bayer |
| 72187-0401-01 | Tagraxofusp injection | $296.34 | $26496.59 | "$31 | 795.90" | Elzonris | Stemline Theraputics |
| 75987-0080-10 | Pegloticase injection | $2968.60 | $22398.79 | "$31 | 038.32" | Krystexxa | Horizon Therapeutics |
| 50242-0082-03 | Ranibizumab injection | $307.20 | $21060.00 | "$27 | 237.60" | Lucentis | Novartis |
| 00078-0734-61 | Canakinumab injection | $115.89 | $15822.31 | "$19 | 932.01" | Ilaris | Novartis |
| 55292-0139-01 | Pasireotide injection | $472.85 | $13667.99 | "$17 | 677.27" | Signifor | Novartis |
| 72694-0954-01 | Pegaspargase injection | $21561.05 | $4377.98 | "$5 | 253.58" | Oncaspar | Shire Pharmaceuticals |
| 47335-0177-95 | Tildrakizumab injection | $133.59 | $14201.65 | "$15 | 428.95" | Ilumya | Sun Pharma |
| 69097-0870-67 | Lanreotide injection | $66.18 | $12805.43 | "$12 | 805.43" | Somatuline | Ipsen |
How did we figure this out?
Why is the discrepancy so high?
Kaiser Permanente operates on a unique model, wherein the insurance company is also the provider. Kaiser owns all of the hospitals and employs all of the doctors within their network. Given that this is the case, it makes sense that the prices they set for their providers would be lower – they have nothing to gain from negotiating higher prices.
United Healthcare, on the other hand, operates like a traditional insurance company. They’re a middleman between providers and patients, and they finance the care the patient receives. Given that they stand to profit from negotiating higher prices, we can see why they would be so much more expensive.
We also noted the wide range of values negotiated by United Healthcare with different providers.For example, for an Aflibercept injection (see the second row of the table), the minimum price is $33,300 USD, and the maximum is $43,068. For a healthcare provider, knowing that the range is so wide is valuable information when negotiating pricing for services.
Having access to this information can help purchasers make more informed decisions about which option to choose. Employers who are purchasing healthcare plans for their company can weigh what plans will provide the most benefit to their employees while still fitting in their budget. Healthcare providers have the information to leverage for better prices. Individuals, while they may still be hampered by the financial challenges of paying for insurance out of pocket, can get a better understanding of what they’re paying for. And because of the size of these data sets, there’s so much more to explore.
