A 'Pink Tax' in Oncology?

August 28, 2023 Andrew Hertler, MD, FACP

Evolent addresses a startling difference in what men and women pay for the same drug.

Do women really pay more for goods and services simply because of their gender? According to numerous sources, they do. A 2015 study by the New York City Department of Consumer Affairs found that, on average, women pay 7% more than men for similar products. Prices were as much as 13% higher for personal care products, such as razors, and 8% more for adult clothing. Even the same or similar toys branded for girls cost 7% more compared to those branded for boys. Over the course of a lifetime, this so-called "pink tax" could add up to as much as $188,000, according to estimates by the state of California.

While a "pink tax" is troubling in the retail market, it's perhaps even more concerning when these disparities crop up in health care. Is it possible that women pay more for the same or similar potentially lifesaving tests, procedures and medications?

In cancer care, the pricing of the medication Lupron Depot (leuprolide acetate) helps illustrate the issue. In men, oncologists treat prostate cancer with a monthly 7.5 mg injection of Lupron Depot, which costs $188 ($25/mg). In women, oncologists deliver the identical medication to treat breast cancer and endometriosis, but it's packaged in a 3.75 mg dose, which costs $1,474 ($393/mg).

It's hard to understand why the same drug costs over 15 times more per milligram for women than for men. The additional cost is passed on to women in the form of increased copayments and out-of-pocket expenses. And of course, health plans also live with the consequences of this price disparity. Whether or not it technically constitutes a “pink tax,” it certainly feels like one.

It's hard to understand why the same drug costs over 15 times more per milligram for women than for men.

Generally, at Evolent, we have found that physicians are unaware of pricing differences, so we use the opportunity to educate them during the prior authorization process. For example, we made the 3.5 mg dose of Lupron Depot "nonpreferred" and educate providers on the more cost-effective 7.5 mg dose. While a greater dose than the patient may require, it is not harmful (though there is the potential for increased "hot flashes," a side effect of all doses of Lupron Depot). We hope that this will reduce costs for patients and payers while also prompting drug manufacturers to re-evaluate their pricing models.

In recent years, state legislation has taken aim at the pink tax. In 2020, New York became the first state to eliminate gender-based pricing for similar goods and services, and California followed suit this year with a similar law taking effect. California defines a product as "substantially similar" if it has a similar intended use, no significant difference in materials, and is of the same brand or owned by the same entity.

Thankfully, Lupron Depot is the only cancer drug our experts have found that resembles this description. Given our growing focus on health equity, we will continue to monitor the ever-changing treatment landscape to ensure that patients and plans aren’t paying more than they should.

About the Author

Andrew Hertler, MD, FACP

As the chief medical officer of Evolent, Dr. Andrew Hertler is responsible for the advancement of the company's clinical quality and value-based strategy, utilization management policies and clinical thought leadership initiatives. A practicing board-certified oncologist for 30 years, he is a nationally recognized leader in oncology clinical practice. Dr. Hertler has volunteered on a number of American Society of Clinical Oncology (ASCO) committees, including the Clinical Practice, Quality of Care and Payment Reform Committees, as well as the Quality Oncology Practice Initiative Certification Program Oversight Council.

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