Insurer groups say hospitals are to blame for higher costs of specialty drugs, while hospitals say the problem stems from drug manufacturers and pharmaceutical benefit managers.
In a report published April 17, AHIP found the average cost per treatment was nearly $8,300 higher for physicians-administered drugs purchased in hospitals than for drugs obtained through specialty pharmacies.
AHIP's report compared prices for the 10 physician-administered drugs that accounted for the most Medicare spending in 2020.
"Health insurance providers are developing innovative solutions every day to make prescription drugs more accessible and affordable, and specialty pharmacies have a big role to play," AHIP President Matt Eyles said in a April 17 news release. "They represent a safe alternative to hospital and physician purchased drugs that can boost access and affordability for all Americans."
Specialty pharmacies handle drugs for rare or chronic conditions not stocked in retail pharmacies. These medications often have high prices.
PBMs often operate their own specialty pharmacies.
In an April 25 blog post, the American Hospital Association said AHIP's report is "fraught with half-truths and methodological flaws."
In the post, the association said AHIP's report does not take into account safety issues that can arise from "brown-bagging" or "white-bagging" drugs, where patients receive medications from a specialty pharmacy and must bring them to their physician to be administered.
The AHA also criticized AHIP's methodology, writing that AHIP drew "sweeping conclusions" from a review of just 10 drugs.
The blame for high prices rests with drug manufacturers, not hospitals, according to the AHA.
"High and rising drugs prices, as well as unaffordable cost-sharing requirements imposed by health plans, put considerable strain on patients and hospital resources. These resources hospitals need to deliver a wide range of high-acuity services that only they can provide, as well as to continue serving as the only site of care that treats all patients regardless of ability to pay," the association said in the blog.
"Neither health insurers, nor their PBM and specialty pharmacy affiliates, have any such obligation to their communities," the AHA added.