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Highmark announces plan to restore more rational payments for cancer care

Payment changes aimed at protecting the affordability of cancer care for Western Pennsylvanians

PITTSBURGH, Feb. 26, 2014 /PRNewswire/ -- Beginning April 1, 2014, Highmark will restore more rational payments for cancer care in Western Pennsylvania by eliminating markups to the cost of certain oncology-related services, including infusion chemotherapy drugs.  The dramatic increase in the cost of infusion chemotherapy treatment has been occurring in Western Pennsylvania and other parts of the country as health systems and large hospitals purchase physician oncology practices, then bill for infusion chemotherapy services as a higher-cost hospital outpatient service, even though the treatment continues to be provided in a physician office.

"Because of this practice, many cancer patients in Western Pennsylvania pay much more for their infusion chemotherapy treatments than they should – without any care improvements," said William Winkenwerder Jr, M.D., president and CEO of Highmark Health. "We feel a responsibility to take action for our members and estimate that this billing change will save our community more than an estimated $200 million annually, with no impact to the quality of cancer care."

The company is restoring more rational pricing for infusion chemotherapy services in response to strong objections raised by our customers, public officials and the community at-large to the costly billing practices for oncology services that have significantly increased the cost of health care, according to Donald R. Fischer, M.D., Highmark's chief medical officer.

"This action will have no negative impact on the quality of care received by cancer patients in our community," said Fischer. "Independent physicians are already providing these services of care at a lower rate. By restoring more rational pricing, a Highmark member being treated for lung cancer could save from $1,000 to $3,500 or more per single treatment, depending on the drugs being used and how the costs are applied to the member's insurance deductible."

The irrational billing practices for cancer care do not impact other areas of Pennsylvania by Highmark, because the company has already addressed the issue through hospital contract negotiations that changed the payment methodology. The impact of cancer costs, however, is a national issue and not isolated to Western Pennsylvania.

The Wall Street Journal has reported that 19 percent of cancer patients are delaying treatment because of the cost and another 23 percent have lost their homes due to treatment costs.  A Kaiser Family Foundation survey indicated that that 25 percent of those or a family member with cancer used up all or most of their savings for treatment, and 11 percent were unable to pay for basic necessities such as food, heat or housing because of the cost of their treatment. 

A recent report of the Medicare Payment Advisory Commission (MEDPAC), agrees that reimbursement for certain health care services should be consistent regardless of the setting in which those treatments occur. It is expected that MEDPAC will formally make the recommendation to congress its March report.

About Highmark Inc.
Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit

SOURCE Highmark Inc.

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