Profitability Of Infused Biologics For Hospitals And Physician Practices: Case Study Of Keytruda.
Physician-administered drugs and biologics account for a growing share of pharmaceutical spending, but they also generate substantial revenues for the hospitals and physician practices that acquire the products at one price and are reimbursed at a higher price. This study analyzed insurer expenditur...
| Published in: | Health Affairs Vol. 45; no. 8; pp. 855 - 862 |
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| Main Authors: | , , , |
| Format: | research tables/charts Journal Article |
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Health Affairs Publishing, LLC
Aug2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=195900402&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 195900402 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Aug2026 vid: 45 iid: 8 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 195900402 195900402 195900402 10.1377/hlthaff.2026.00334 195900402 ppf: 855 ppct: 7 formats: tig: atl: Profitability Of Infused Biologics For Hospitals And Physician Practices: Case Study Of Keytruda. aug: au: Robinson, James C. Kosorukuv, Ari Thomson, Mark Whaley, Christopher M. affil: University of California Berkeley, Berkeley, California sug: subj: Biological Products Economics Health Facility Costs Profits Insurance, Health, Reimbursement Physicians Practice Patterns Human United States Antibodies, Monoclonal Economics Billing and Claims Health Insurance Exchanges Federal Government Insurance, Health Confidence Intervals Multivariate Analysis Funding Source ab: Physician-administered drugs and biologics account for a growing share of pharmaceutical spending, but they also generate substantial revenues for the hospitals and physician practices that acquire the products at one price and are reimbursed at a higher price. This study analyzed insurer expenditures and provider margins with a focus on Keytruda, the world's largest biologic in terms of sales, using detailed insurer, provider, and market data on 59,717 patients treated in 5,008 hospitals and physician practices. Keytruda expenditures by private insurers increased by 142 percent from 2020 to 2024, while the number of patients using Keytruda increased by 110 percent. Price markups--the ratio of the reimbursement price charged to insurers compared with the acquisition price paid to the manufacturer--averaged 173 percent in hospitals eligible for 340(B) discounts, 78 percent in hospitals not eligible for those discounts, and 16 percent in community-based physician practices. For hospitals eligible for 340(B) discounts, each Keytruda patient was associated with $102,680 in annual revenue, measured through insurer reimbursement, after organizational, patient, and market factors were adjusted for. Each Keytruda patient was associated with $67,825 in revenue at noneligible hospitals and $3,094 in revenue at physician practices. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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