EP282: Do You Know How Much Cancer Centers Get Paid to Put Patients on Drugs? With Aaron Mitchell, MD, MPH

In this Episode 282, Stacey Richter talks with Aaron Mitchell, MD, MPH, an oncologist and health services researcher at Memorial Sloan Kettering, about how much cancer centers get paid to put patients on drugs.

WHAT YOU'LL LEARN

✅ How the "buy and bill" payment model pays cancer centers a percentage of the drug's cost to infuse it

✅ Why this model creates a built-in incentive to gravitate toward more expensive drugs

✅ How financial toxicity affects patients even when the clinical benefit of a drug is marginal

✅ What reimbursement reform and capitated systems could look like as alternatives

✅ Why large and small oncology providers experience the buy-and-bill system differently

WHY THIS MATTERS

Aaron Mitchell lays out how the buy-and-bill payment model — where cancer centers buy chemo drugs and get reimbursed a percentage on top for infusing them — quietly rewards prescribing the most expensive option, since the fee scales with drug cost. As cancer drug prices climb, so does the money earned by the centers infusing them, while patients absorb greater cost sharing and employers and taxpayers foot much of the rest. Mitchell argues this dynamic is one reason financial toxicity gets so little institutional attention: the current system, as he puts it, works too well for too many people for change to come easily, even though patients are the ones losing out.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:00 Following the drug and following the dollar.

03:28 The "buy and bill" system.

04:15 The perverse and problematic incentives of the system.

07:24 "It creates the incentive for us to gravitate toward the more expensive drug."

07:28 The hesitancy to address the financial toxicity of drugs for patients.

08:40 Why the only person losing in this situation is the patient.

09:40 The financial impact from the patient perspective.

13:07 Are patients realizing this impact?

13:53 Solving the problem of oncology drug choice.

16:06 Reimbursement reform.

17:49 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like.

23:04 Are we at a tipping point?

23:27 "The current system … works too well for too many people."

24:47 Who isn't well served by the current system.

26:27 Who has to lead the charge for change.

29:54 Large oncology providers vs small oncology providers in the buy and bill system.