Episode 501

Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD

Feb 26, 2026

39:57

Episode Description

Two members of a plan received infusions at a hospital. If they had gone down the street, the plan would have spent $1 million less — for the same drug. That is the infusion nonmarket in 2026.

In this episode, Stacey Richter speaks with Ivana Krajcinovic, the outgoing Vice President of Healthcare Delivery at UNITE HERE HEALTH, who spent over three decades protecting the health and wages of 230,000 hospitality workers, about what plan sponsors can actually do when they discover their members are paying $13,560 for a drug available down the street for $135.

WHAT YOU'LL LEARN

✅ The price variation data from real claims: Oxaliplatin, a generic cancer drug long off patent, costs Medicare $35 per administration and an independent practice charges $135 — but a Chicago hospital was charging $13,560 for the same drug; in Monterey, a series of Oxaliplatin infusions that Medicare would have paid $185 for was billed at $90,000 — a markup of nearly 500 times

✅ The human cost: in Monterey, members getting chemo on 20% co-insurance routinely hit their out-of-pocket maximums by February — and every dollar going to hospital markups is a dollar not available for the next wage increase, meaning workers pay twice

✅ Why lazy carrier networks are the second tell of a nonmarket: the Chicago hospital and its in-house physician practice were in the same system and both in network — the network paid the two providers very different amounts itself, then told the plan sponsor not to worry because "it all comes out even in the end"

✅ The direct contracting win in Monterey: an independent oncology practice charging 100–150% of Medicare — compared to 800% at the hospital — agreed to a direct contract, moved a Crohn's patient from $38,000 for four biosimilar infusions to $5,000, and eliminated her out-of-pocket costs entirely

✅ How UNITE HERE HEALTH built the roadmap: drill into claims data to find drug codes with surreal price variation; redesign benefits to make the direct-contracted practice free to members; carve out UM/CM to a vendor accountable only to the plan; use bilingual outreach staff who call after 5pm so hourly workers actually answer

✅ The Whack-a-Mole dynamic and why collective action matters: when Ivana challenged the Monterey hospital COO directly, the hospital eventually removed the drug from its price transparency file rather than lower the price — but if two or three large payers in a market do the same thing, the pricing pressure becomes real

WHY THIS MATTERS

Functioning markets rationalize prices. When two places in the same geography charge 500 times different for the same drug and both stay in business, there is no market. Waiting for one to fix this is, as Stacey puts it, magical thinking. What Ivana describes is a plan sponsor acting as its own demand curve: find the independent practices, build the direct contracts, align the UM/CM vendor, make the high-value setting free to members. The independent oncology practice in Monterey asked for 150% of Medicare and Ivana almost jumped across the table to say yes. Because 150% beats 800% by a lot.

=== LINKS ===
🔗 Show Notes with all mentioned links:
https://bit.ly/Episode501

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00:00 $135 vs $13,560: How infusion drug prices play into the "Inches All Around Us" series.

02:02 How infusion drug pricing fits into the "No Market" series.

03:19 A roadmap and more episodes on this topic.

04:36 Introducing this week's expert, Ivana Krajcinovic, PhD.

05:10 A must-read Bloomberg News article on infusion pricing.