If you’ve received an explanation of benefits from your insurance after a hospital-based infusion, you may have done a double take. A single dose of Remicade or Ocrevus or Tysabri can show a hospital charge of $20,000, $40,000, or more. Even with insurance, your share might be hundreds or thousands of dollars per visit. The same treatment at an outpatient infusion center often costs a fraction of that — sometimes one-fifth as much — with the same drug, the same nurse-administered protocol, and the same clinical outcome. So what’s going on?
The short answer: site-of-care pricing
In American healthcare, the cost of a treatment depends heavily on where it’s given, not just what is given. Hospitals are allowed to bill significantly more than outpatient facilities for the exact same medications and services, even when the clinical care is identical. This is called “site-of-care” pricing differential, and it’s one of the most consequential and least-discussed features of how American healthcare is priced.
The cost difference isn’t about better care. It’s about how hospitals are allowed to package and bill for services.
Why hospitals charge more
Several structural factors push hospital infusion costs higher:
Facility fees. Hospitals charge a separate “facility fee” for the use of their building — on top of the drug cost and the administration fee. This can add hundreds or thousands of dollars per visit. Outpatient infusion centers typically have no separate facility fee or a much smaller one.
340B drug pricing reimbursement. Many large hospitals participate in the federal 340B drug pricing program, which lets them buy expensive drugs at deep discounts — sometimes 30 to 50 percent below market price. But hospitals are still allowed to bill insurers at full sticker price (or close to it). The difference between the discounted purchase and the inflated bill becomes hospital revenue. This is legal, well-established, and one of the largest profit centers for many hospital systems. It also means the patient and insurance company often pay multiples of what the hospital actually paid for the medication.
Cost-shifting from uncompensated care. Hospitals provide a substantial amount of unreimbursed care — emergency department visits for uninsured patients, indigent care, services that insurance won’t cover. Those costs have to come from somewhere, and one of the places they come from is higher pricing on profitable services like infusion therapy.
Higher overhead. Hospitals have substantial fixed costs — 24/7 emergency services, large physical plants, complex bureaucracies, accreditation requirements, and dozens of departments. Those overhead costs get distributed across all the services the hospital provides, including outpatient infusion. An outpatient infusion center has a fraction of the overhead.
Negotiated insurance rates. Insurance companies and hospitals negotiate reimbursement rates, and large hospital systems often have substantial leverage. They’re paid more per service than smaller outpatient providers, even for identical care.
What this means for your bill
If you have a high-deductible plan or significant coinsurance, the difference between hospital and outpatient infusion can translate to thousands of dollars in out-of-pocket cost per year. For someone on a chronic biologic infusion every 8 weeks, that’s roughly six to seven infusions annually. Even at a 20 percent coinsurance after deductible, the math at a hospital can run to tens of thousands annually. The same care at an outpatient center can run to hundreds or low thousands.
And it’s not just patients. Self-funded employers and insurance plans pay more for hospital-based infusions, which gets passed through to all of us in the form of higher premiums.
Why this exists
Site-of-care pricing differentials are baked into Medicare’s reimbursement structure (specifically the difference between the Hospital Outpatient Prospective Payment System and the Medicare Physician Fee Schedule), and commercial insurance has largely followed suit. There have been multiple legislative attempts to reform this — particularly site-neutral payment reform — but progress has been slow because hospital lobbying is among the most effective in healthcare policy.
It’s an issue of how American healthcare is structured, not a quality-of-care issue. The infusion administered at the hospital is identical to the one administered at a good outpatient center.
What you can do about it
If you’re currently getting infusions at a hospital and the cost is hurting, you have options:
1. Ask your doctor about transferring to an outpatient infusion center. Most prescribing physicians can write the same order to an outpatient infusion center. Your treatment, dosing, and schedule remain identical — only the location changes. Insurance typically covers outpatient infusion at preferred rates, and many plans actively prefer it.
2. Verify your insurance coverage in advance. A reputable outpatient infusion center will run a full benefits verification before your first visit. You’ll know your expected cost — copay, coinsurance, deductible impact — before you commit. No surprise bills.
3. Ask about manufacturer copay assistance. Most biologic manufacturers offer programs that significantly reduce or eliminate patient copays. These programs work at any infusion site — hospital or outpatient — but the savings stack on top of already-lower outpatient pricing.
4. Consider Medicare Part B vs. Part D coverage. Some infusion drugs can be billed under either Medicare Part B (medical benefit) or Part D (pharmacy benefit), and the patient cost can differ substantially. A good infusion center will help you understand which option is more favorable for your specific situation.
5. Don’t skip treatment because of cost — switch sites instead. The most expensive thing you can do is stop biologic therapy because of cost, then have a flare or progression that requires hospitalization. The right move is usually to find a cheaper site of care for the same treatment.
Is the care actually the same?
For most patients, yes. Outpatient infusion centers administer the same FDA-approved medications under the same protocols, with the same trained nursing staff, the same monitoring, and the same emergency procedures. For patients with stable chronic conditions on standard biologic therapy, there’s typically no clinical reason to be receiving infusions in a hospital.
There are situations where hospital infusion makes sense — some highly complex patients, certain rare protocols, or treatments that require specialized resources. Your prescribing physician can tell you whether outpatient infusion is appropriate for your specific case.
At Arbor
We’re an outpatient infusion center serving North Atlanta because we believe the hospital pricing model has gotten out of hand for what is, fundamentally, a routine infusion. We administer biologics, IVIG, iron infusions, and specialty therapies at a fraction of hospital pricing — typically 40 to 70 percent less — in private suites with experienced registered nurses.
If you’re currently receiving infusions at a hospital and want to explore switching, contact us. We’ll verify your benefits, coordinate with your prescribing physician, and give you a clear estimate of cost before your first visit. The clinical care is the same. The bill won’t be.