Author: Wayne Winegarden

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June 16, 2025 Blog

International drug price comparisons aren’t just like comparing apples and oranges, they’re like comparing apples and iPhones. That’s because half of brand drug spending in the U.S. goes to PBMs, 340B hospitals and other middlemen, a dynamic that doesn’t exist in other countries. In some instances, the revenues of some U.S. middlemen exceed the total cost of medicines in other countries by as much as 700 percent. I previously highlighted how estimated rebates and fees PBMs receive for 10 commonly used...

June 11, 2025 Briefs, Studies

The Pacific Research Institute’s Center for Medical Economics and Innovation today released a new issue brief warning that continued federal underpayment of doctors is fueling a looming healthcare crisis by accelerating the nation’s physician shortage and undermining access to care. Written by PRI senior fellow in business and economics and CMEI director Dr. Wayne Winegarden, the brief (titled “It’s Time for Medicare to Stop Shortchanging Physicians”) finds that Medicare reimbursement rates are well below market value and have failed to keep...

May 22, 2025 Blog, Price and Costs

To Improve Drug Affordability Congress Should Fix the Payment System President Trump has issued an Executive Order (EO) demanding that drug prices in the U.S. equal the lowest price among comparable industrialized countries. This EO fails to understand the complex drug payment system and threatens to harm patients. Demanding that drug prices in the U.S. equal overseas prices is akin to demanding that the price of all expensive handbags should equal the prices for the knockoffs that people purchase from street vendors. Of...

April 23, 2025 Issues, Price and Costs

At the top of the new executive order’s priorities for pharma is the pill penalty, which Trump said threatens innovation and favors biologics. Currently, small molecule drugs are eligible for price negotiations sooner than biologics — nine years versus 13 years — and critics have said the law disincentivizes small molecule R&D. The order asks Kennedy to work with Congress to end “the distortion that undermines relative investment in small molecule prescription drugs.” “We’re already seeing it where research is being skewed...

April 20, 2025 Innovation, Issues

Surveys confirm that most Americans recognize the value of prescription drugs. But the same surveys also show that Americans are worried that they will be unable to afford needed medicines. These conflicting feelings exemplify the inherent tension when it comes to prescription drugs – how do we incentivize innovation to help patients who lack efficacious treatments while also promoting greater affordability for medicines today? Too often, proposals get this balance between innovation and affordability wrong. Read the entire op-ed. ...

April 7, 2025 Innovation, Issues

Rising demand for long-term care is inevitable as more and more baby boomers retire. Meeting this demand will be a challenge. Recent evidence from the PACE program demonstrates that for-profit care providers can help meet this growing demand, but only if the regulatory environment allows it. Read the entire op-ed here....

March 24, 2025 Blog, Innovation, Price and Costs

An analysis by the American First Policy Institute released today correctly notes that the drug price controls most OECD countries impose on innovative medicines jeopardize future innovations. Yet, while correctly diagnosing their high cost, the authors still recommend that price controls should be imposed on U.S. patients. Adopting such a policy will worsen health outcomes while potentially raising overall healthcare spending even more. The cost of capital for developing a new drug is $2.9 billion, including post approval research and development costs. Meanwhile, the...

February 27, 2025 Briefs, Price and Costs, Studies

SACRAMENTO – Nevada taxpayers could face millions in new bureaucratic costs and patients will likely see less access to life-saving drugs if state government mandates so-called “Maximum Fair Price” price controls on prescription drugs, finds a new brief released today by the Center for Medical Economics and Innovation at the nonpartisan, California-based, free-market think tank, the Pacific Research Institute. “Some Nevada lawmakers want to enact government price controls on prescription drugs in the name of lowering costs for patients,” said Dr....

January 22, 2025 Innovation, Issues

CMS recently announced the next 15 drugs that will be subject to price negotiations under the Inflation Reduction Act of 2022 (IRA). These are negotiations in name only because CMS can levy penalties on any manufacturer that fails to comply with the process. Since the penalties include an excise tax up to 95% of a drugs total U.S. sales revenue, the law essentially empowers CMS to set its desired prices (e.g. price controls). Price controls discourage R&D spending. With less investment...

January 7, 2025 Briefs, Innovation, Price and Costs, Studies

READ THE PDF Executive Summary Reforms that will strengthen the biosimilar market and expand savings opportunities include: Reforming (ideally repealing) the Inflation Reduction Act’s price control measures. Improving the incentives underlying the current buy-and-bill system to better align the financial incentives of providers, payers, and patients. Promoting greater transparency to the opaque drug rebating system including addressing the rebate wall problem through comprehensive reform or prohibiting the anti-competitive rebating practices that are generally outlawed in other markets. Given biosimilars’ demonstrated ability to...

December 2, 2024 Briefs, Innovation, Price and Costs, Studies

READ THE PDF Executive Summary The Inflation Reduction Act’s price controls discourage biosimilar development. Payment system inefficiencies, such as the buy-and-bill payment system and rebate walls, disincentivize the use of lower cost biosimilars. Despite the savings biosimilars have already enabled, there are barriers to further progress. First, the price controls from the Inflation Reduction Act (IRA) disincentivize biosimilar development. Second, the convoluted pricing system discourages greater use of lower cost alternatives. How the payment system disincentivizes their use varies depending on whether...

October 28, 2024 Briefs, Innovation, Price and Costs, Studies

READ THE PDF Executive Summary Since 2019, biosimilars have obtained a majority share of most markets where they compete. The combination of lower prices (both biosimilar and originator) and rising market share could have generated up to $35 billion in savings in 2024 dollars compared to an all-originator baseline based on PRI’s latest analysis. These savings demonstrate that, just like with small molecule medicines, biosimilars strike a beneficial balance between incentivizing innovation and promoting affordability. Lower-cost Biosimilars Are Gaining Market Share The share...

October 23, 2024 Issues, Multimedia, Policy Proposals, Radio

“On the other side of the political spectrum is Wayne Winegarden, Ph.D., the Senior Fellow in Business and Economics at Pacific Research Institute, and Director of PRI’s Center for Medical Economics and Innovation. “He and his colleagues believe that patients are not in control of the health care system and that we suffer from an opaque and complex pricing structure that harms patients. “Winegarden’s free market approach means he advocates for doing away with the Obamacare subsidies that Congress must consider, as...

October 1, 2024 Briefs, Innovation, Studies

READ THE PDF Executive Summary In the competitive biologic markets, biosimilars have reduced average prices by 56 percent. The lower prices have reduced total expenditures by 51 percent in the competitive biologic markets even though total use is higher. Developing biosimilars is a long and costly endeavor that can take up to 9 years and $300 million. Market conditions should encourage uptake and appropriate reimbursement for physicians and manufacturers. Biologics – innovative medicines made, or derived, from biological processes – treat devastating...

September 18, 2024 Innovation, Price and Costs

In a patently politicized press release, Senator Bernie Sanders (I-VT) who is  Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, claims that the U.S. price of Ozempic is too high. As evidence, he cites generic companies that claim they can sell Ozempic for less than $100 a month, an inherently flawed JAMA study that claims that these same diabetes drugs can be profitably produced for less than $5 a month, and inaccurate price comparisons with other countries. Debunking...

September 9, 2024 Policy Proposals, Price and Costs

The Inflation Reduction Act (IRA) effectively imposed price controls on a portion of the pharmaceutical market. Worse, by design, the reach of these price controls will expand every year. The intended consequence of the policy is to reduce overall spending on drugs, but all regulations have unintended consequences, too. While these consequences may be unintended, they need not be unexpected. In the case of the IRA, these unintended impacts now threaten to undermine the entire purpose of the policy. Read the full...

August 26, 2024 Innovation

The ill effects from abusive lawsuits are well documented and include higher costs for consumers, reduced economic output, and diminished innovation. The adverse impacts on innovation are particularly troubling. Not only is continued invention necessary for expanding our prosperity, but it is also key for mitigating problems such as global climate change or finding new technologies and treatments for troubling health conditions....

July 25, 2024 Briefs, Studies

SACRAMENTO – A new brief released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute finds that artificially low reimbursement rates used by Medicare to contain costs are threatening patient care, and reform is needed to prevent future doctor shortages. Click to download the brief “Price controls used by government-run health care systems globally to contain costs lead to delays, lower quality, and worse health outcomes,” said Dr. Wayne Winegarden, director of PRI’s Center for Medical...

June 11, 2024 Briefs, Innovation, Resources, Studies

A new brief released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute provides the latest evidence that biosimilar competition is saving patients billions – and additional competition would increase savings even more. Click to download the brief From 2019-2023, patients saved $15 billion from biosimilar competition.  Had there been competition during the same period for two other biologics, Humira and Enbrel, patients would have saved another $13 billion, for a total of $28 billion. “The growing...

April 12, 2024 Issues, Price and Costs

Barber et al. just published a fundamentally flawed study on diabetes medicines in JAMA Network Open (JNO). This study wrongly suggests that cost-based pricing accurately values innovative on-patent medicines, distracts from serious policymaking, and fuels political grandstanding by politicians such as Senator Bernie Sanders. Cost-based pricing could be an economically viable pricing strategy for generic drugs. Mark Cuban’s Cost Plus Drugs (CPD), launched in 2022, is attempting to disrupt the generics industry using this pricing model. CPD sells generic medicines directly to consumers...