The market is moving faster than most infusion strategies can keep up with

By John Reade

SVP Growth Strategy and Operations, Leap

Hospital systems have been acquiring independent physician practices at a rapid pace for close to two decades, and infusion-heavy specialties like oncology and rheumatology have been common targets. 

Research published by Yale's Zack Cooper and Fiona Scott Morton found the share of physician practices owned by hospitals rose 71.5% between 2008 and 2016. Hospital and corporate ownership of physician practices reached 59% as of 2023, up from 39% just four years earlier. 

Once an independent practice is folded into a hospital system, the same clinicians, in the same building, seeing the same patients, get reclassified as a hospital outpatient department. That reclassification alone can trigger payment increases of anywhere from 100 to 200% for the same care. 

In the third and final post in this series on what's actually driving specialty infusion costs, I wanted to look at this market force and two others that are compounding the problem:

• Employers and payers respond by locking down access.
• A specialty drug pipeline that keeps growing with no plan to handle the volume.

And check out the first and second blog posts in this series on site-of-care changes and the pricing values you should seek from every solution. 

When employers push back, the impact often lands on members instead of providers

Faced with rising specialty drug spend, a common employer and payer response is to restrict where and how a drug can be obtained through one or more of the following:

• Narrowing access to the pharmacy network.
• Requiring a specific specialty pharmacy to supply the drug directly to the provider (commonly called white bagging or brown bagging). 
• Limiting which sites can bill for a given therapy.

These restrictions can lower the price on paper. But they also introduce real friction, and that friction lands on the member. A patient who's built a relationship with a provider over months or years can lose access to that provider altogether if the site isn't set up to accept a specific pharmacy's drug under the new rule. 

Many providers are also hesitant to accept an outside drug into their own clinic, so the member is often the one left to: 

• Find a new site willing to administer it.
• Sort out the logistics.
• Figure out what happens to their treatment schedule in the meantime. 

That access gap has been serious enough that 12 states have banned mandatory white and brown bagging.

When a restriction like this pushes someone off therapy, even briefly, there are consequences. Published research on biologic therapy adherence found that patients who fall behind on treatment face meaningfully higher odds of an emergency room visit and hospitalization than patients who stay on schedule. That means gaps in access can lead to higher-cost care down the road. 

More drugs are coming, and few strategies are built to scale with that

The volume of specialty drugs available is growing rapidly. In 1995, there were about 30 specialty drugs on the market. Today, there are nearly 1,000, and roughly 75% of the 7,000 drugs moving through the FDA pipeline are specialty drugs.

Leap supports more than 200 of the specialty therapies driving this trend, including cancer, multiple sclerosis, rheumatoid arthritis, Crohn's disease, ulcerative colitis, migraine, immunodeficiency disorders, and other complex or chronic illnesses.

Growing availability of these drugs means your employees will have more conditions for which an infusion or injection therapy exists to support their care. That’s big news for them since treatment through infusion can improve absorption of medication for a patient. 

A cost-containment strategy has to work for whichever drug enters the picture next year, not just the ones already on the formulary.

What benefits leaders can do about this today

So what can you, as a benefits leader, do to really move the needle? 

• Frame the challenge upward as structural, not a spike. A renewal-cycle cost increase reads differently to a CFO than a market shift that will keep recurring. Naming hospital consolidation, access restrictions, and prevalence explicitly, rather than letting them show up as an unexplained line-item jump, makes the multi-year planning conversation easier the second time around.
• Request your own claims and understand the cost drivers. A drug that suddenly costs more for the same patient, same dose, same diagnosis is worth a second look at whether the billing entity changed, not just the price. That pattern is often the clearest sign a local practice got folded into a hospital system. Ask your carrier for a detailed list of these claims.
• Ask any current or prospective vendor the handful of questions from our previous post in this series: What the drug actually costs to acquire versus what's being billed, whether the claim is itemized or bundled, whether the savings are validated against a paid claim or just projected, and whether the claim would hold up if someone broke it into parts and reviewed each line.
• Evaluate point solutions on whether their pricing depends on conditions holding steady. A program that prices well today but assumes the current site-of-care map, network structure, or drug list stays fixed is building on the exact ground that's shifting.

A consultant who already runs claims-based analyses across a book of clients is well positioned to help spot these patterns before they show up in a renewal number instead of after.

To recap

Site of care, the claim itself, and the market forces covered here turn out to be three layers of the same rising costs problem. And the market underneath any claim keeps pushing that problem in the wrong direction, even when nothing about the care itself has changed.

None of this is a reason to wait for the market to settle down. It won't. What's worth asking for instead is a pricing and access model that doesn't move every time a practice changes hands, a network narrows, or a new drug launches, because that's the only kind of answer built for a market that keeps doing all three.

Instead, look for a partner that provides a transparent pricing model, member-centric care, and consultative advice on how best to navigate this changing landscape. 

Request an impact analysis from Leap today using your own data to help you understand how you can better contain rising specialty drug costs.

About the author

Reade is the SVP Growth Strategy and Operations at Leap. He joined Leap in December of 2025. Reade builds and refines the claims-based savings analysis that proves Leap's value and shapes the company's go-to-market strategy.

Read Part 1 and Part 2 of this series.