Evidence mapPaperPMID 41648645Full record

ArticleHealth policy OPEN2026

Price transparency & out-of-pocket payments for medications: Implications of associated delivery fees in the United States.

Deborah R Kaye, Hui-Jie Lee, Daniel J George, Charles D Scales, M Kate Bundorf

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Article in Health policy OPEN, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Deborah R KayeDepartment of Urology, Duke University, Durham, NC, USA.
Hui-Jie LeeDepartment of Biostatistics, Duke University, Durham, NC, USA.
Daniel J GeorgeDuke Cancer Institute, Durham, NC, USA.
Charles D ScalesDepartment of Urology, Duke University, Durham, NC, USA.
M Kate BundorfDuke-Margolis Center for Public Policy, Duke University, Durham, NC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Price transparency has been cited as a tool to reduce out-of-pocket (OOP) payments to patients. These tools for prescription drugs often focus on the price to patients for the drug alone. However, costs associated with drug delivery (i.e. infusion center fees, labs, etc) are often unknown and could impact the effectiveness of price transparency tools. Objective: To examine total OOP payments on day of drug receipt ("full day", i.e. drug + drug administration fees) out-of-pocket (OOP) payments associated with six first-line treatments for metastatic castrate resistant prostate cancer and compare these with payments for drug alone and by insurance type. Methods: Using the IBM Marketscan databases, we identify male patients who initiated treatment with one of six focus drugs (docetaxel, abiraterone, enzalutamide, sipuleucel-T, cabazitaxel, and radium-223) used to treat mCRPC from 07/01/2013-06/30/2019. We calculated total OOP payments on day of drug receipt (full day OOP payments) by drug type for six first line treatments. We then used a two-part model to assess the association of first-line therapy with OOP payments for the four most frequently prescribed during the study time period. Results: We find that there is variation in the proportion of payments for drug alone relative to full day payments across first-line treatments. However, regression-adjusted mean full day OOP payments are not statistically different across first-line treatments for mCRPC for the four most frequently prescribed drugs. There are differences in the likelihood that an individual will incur any OOP payment by first-line treatment type and by health plan type. Conclusion: These analyses suggest that when accounting for additional services required on the day of drug receipt, the amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for the drug alone; these payments also vary by drug and health plan type. Therefore, price transparency for drug alone may not lead to reduced OOP payments for patients.

Identifiers

PMID41648645
PMCPMC12870800

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