The Hospital Chair Costs $102,680

I cannot unsee a number from this month’s Health Affairs.

They studied Keytruda, the cancer drug sitting at the top of a lot of employer pharmacy bills. Same vial. Same drip. And 340B hospitals booked $102,680 a year in insurer revenue for each of those patients. A community physician practice booked $3,094.

That is not the cost of the medicine. That is the cost of the chair.

Those hospitals buy the vial at a discount, then bill the plan as if the discount never happened. The markup over what they paid the manufacturer averaged 173 percent in 340B hospitals. In a regular doctor’s office it was 16 percent. Private insurers spent 142 percent more on Keytruda in 2024 than in 2020. The patient count did not grow that fast. The building did.

I do not hang that bag in a Wichita exam room. I do sit with shop owners who treat their premium like a second payroll. They are not buying extra oncology. They are buying a hospital’s right to charge a specialty price for a drug that already has a clinic price. Insurance belongs on the wreck. It does not belong on the chair.

Post the number. Buy the vial. Sit the patient down. Charge for the care, not the ZIP code of the recliner.