Author: Wayne Winegarden

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January 18, 2023 Issues, Policy Proposals

The U.S. Departments of Labor and Health and Human Services has issued a new joint federal rule. Another federal mandate is hardly newsworthy, but one devised under the Trump Administration and eagerly implemented by the Biden Administration is certainly unique. Beyond the politics, the Transparency in Coverage rule, while not without its shortcomings, helps to address on one of the fundamental flaws worsening the effectiveness of the nation’s healthcare system – its opacity. The lack of transparency that pervades the healthcare system...

January 4, 2023 Briefs, Studies

DOWNLOAD THE BRIEF   Executive Summary Declining productivity growth in the delivery of healthcare is not innate to the sector. It simply reflects the current policy environment. Incentivizing a more productive and cost-effective healthcare provider sector is possible but requires comprehensive policy reforms that eliminate the obstacles blocking progress. These reforms include: Implementing the insurance reforms discussed in Part 5 that, from a provider perspective, will incentivize the creation of innovative payment models. New payment models create opportunities to better align the incentives...

December 16, 2022 Issues, Price and Costs

Three days before Christmas, the Institute for Clinical & Economic Review (ICER) is scheduled to publish a draft assessment of two promising treatments for Alzheimer’s disease. Unfortunately for the millions of Americans living with this fatal illness, it is likely that ICER will be giving lumps of coal, not gifts, this holiday season. ICER performs studies that declare how much we as patients value medicines that treat devastating diseases like Alzheimer’s. And depending upon their proclamations, patients’ access to life-altering medicines...

November 16, 2022 Briefs, Price and Costs, Studies

SACRAMENTO – The broken 340B program, designed to provide affordable care for at-risk patients, creates massive profits for providers without necessarily improving patient health outcomes and should be reformed, finds a new issue brief released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute. Click here to download a copy of the brief “The 340B program is growing unsustainably and isn’t improving health outcomes for at-risk patients,” said Dr. Wayne Winegarden, the Center’s director and the...

October 10, 2022 Briefs, Price and Costs, Studies

CLICK HERE TO READ THE BRIEF In addition to the reforms to the health insurance system, which will help address the problems of drug affordability, reforms tailored to the pharmaceutical sector are necessary. These reforms should eliminate drug supply chain inefficiencies and include: fostering a patient-controlled generics market, creating price transparency through reforms that ensure patients directly benefit from all discounts when purchasing their medicines,  fixing the drug formularies’ systemic biases against low-cost medicines, and encouraging contracting innovations that could create...

October 3, 2022 Issues, Price and Costs

The Centers for Medicare & Medicaid Services issued an update to the home health payment system on June 22nd. This proposed rule, rife with legalese and sheer complexity, should be held up as Exhibit A for why socialized healthcare schemes such as Medicare for All will never work. The proposal’s obsessions with “aggregate expenditures” and “overall utilization” reveal one of the fundamental flaws of government-run healthcare – the belief that bureaucrats can efficiently serve individual’s needs by imposing aggregate caps and regulations based on population...

September 6, 2022 Issues, Policy Proposals

The Centers for Medicare and Medicaid Services (CMS) recent decision on home healthcare services, if implemented, will increase overall healthcare expenditures and decrease the quality of services received by patients. CMS’ overarching goal is praiseworthy – the agency is trying to maintain budget neutrality while changing its payment system rates. A more praiseworthy goal would be to reduce expenditures but that is a different question, the larger problem is that CMS’ proposed expenditure reductions will more likely increase spending over time. At...

August 30, 2022 Issues, Policy Proposals

Pharmacy benefit managers (PBMs) deploy numerous anticompetitive actions, which have not gone unnoticed. The Federal Trade Commission (FTC) has launched an inquiry to examine whether PBMs have adverse impacts “on the access and affordability of prescription drugs.” The government’s probe is welcome news. But there are many detrimental PBM practices that are creating unwarranted risks to patients’ health and, consequently, require remedying sooner rather than later. The growing restrictions on where providers can source their drugs, a practice referred to as white bagging,...

August 22, 2022 Briefs, Industry Trends, Price and Costs, Studies

SACRAMENTO – Biosimilars competition saves patients and the health care system over $11 billion annually and could generate even more savings if the broken drug pricing system were reformed, finds a new issue brief released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute. “Patients living with cancer, autoimmune diseases, osteoporosis, and other illnesses are receiving revolutionary treatment from biologics,” said Dr. Wayne Winegarden, the Center director and the study’s author. “As our research shows,...

July 25, 2022 Briefs, Price and Costs, Studies

CLICK HERE TO READ THE BRIEF Establishing an Efficient Health Insurance Market Cultivating an efficient health insurance market requires reforms that empower patients over payers, which can be achieved by: Making health expenditures and health insurance expenditures tax deductible;  Broadening the availability and usability of tax-free saving accounts to help patients cover the deductibles and out of pocket expenses that could arise should they require costly healthcare services; and Promoting price transparency and insurance competition to enable a more competitive pro-patient healthcare...

June 15, 2022 Innovation, Issues

The House passed bipartisan legislation last week that could help reduce costs and ensure continued innovation for the future. While this legislation might not be covered as extensively as other issues, it nonetheless represents meaningful progress. This week, the Senate HELP Committee passed the Senate version, the Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act, a reauthorization of Prescription Drug User Fee Act (PDUFA), the Biosimilars User Fee Act (BsUFA), and the Generic Drug User Fee Amendments (GDUFA). These...

June 7, 2022 Issues, Policy Proposals

Entrepreneurs, empowered by competitive markets, drive economic progress. When market regulations incentivize productive activities, entrepreneurs radically improve existing goods and services and create new products we never knew that we couldn’t live without. The wrong regulatory structures misalign these positive incentives. They thwart or misappropriate entrepreneurial efforts resulting in lost opportunities to improve consumer welfare and, when the disincentives are particularly pernicious, can even worsen consumer outcomes. A fitting example is the policy obstacles in the drug market that empower industry...

May 2, 2022 Issues, Price and Costs, Radio, Resources

Listen to the author of a new study discuss how America’s broken third-party healthcare payment system prioritizes government and insurance companies as the largest payers, leaving patients with higher out-of-pocket costs, greater exposure to healthcare financial risk, and reduced access to care.  To learn more, read the "Coverage Denied" series from PRI's Center for Medical Economics and Innovation. ...

April 28, 2022 Briefs, Price and Costs, Studies

America’s broken third-party healthcare payment system prioritizes government and insurance companies as the largest payers, leaving patients with higher out-of-pocket costs, greater exposure to healthcare financial risk, and reduced access to care - finds the latest paper in the Coverage Denied series released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute. Click here to read the brief “The healthcare marketplace should prioritize the needs of patients, but our broken third-party payment system caters to insurers...

April 20, 2022 Issues, Price and Costs

Sustainably addressing the problems of rising prices and declining quality requires reforms that empower patients and doctors, improve price transparency, and eliminate the perverse incentives of our current health insurance system that drive up costs and limit care. Instead of addressing the health care system’s core deficiencies, policymakers push for counterproductive policies like price controls. Efforts in Indiana show that politicians do not need to pass legislation to implement bad ideas. The threat of legislation is sufficient. Indiana’s Senate President Pro Tempore...

March 14, 2022 Issues, Price and Costs

As President Biden's recent State of the Union address made clear, drug pricing will remain a top policy issue for the foreseeable future. The president is correct that something must be done, but his proposals are wrongheaded and will only make things worse. Instead of focusing on government price controls, Congress should remove the obstacles limiting patient control and choice. The claim that prices are lower, and quality is higher, when consumers have more choices is typically uncontroversial. Yet, for some reason...

March 1, 2022 Briefs, Policy Proposals, Price and Costs, Studies

READ THE REPORT The problem of drug affordability is caused by the perverse incentives created by the third-party payer system that have disempowered patients in favor of insurers and other supply-chain intermediaries. The insurance flaws have created pricing systems that inequitably transfer a disproportionate share of drug costs on to patients. This arrangement inappropriately imposes a drug affordability problem on patients who require expensive medicines. The insurance flaws also incent benefit design policies that create additional affordability burdens and unnecessarily increase...

February 28, 2022 Issues, Price and Costs

Too often, regulations undermine the competitive process in the name of promoting competition. The ill-conceived Right to Repair legislation exemplify the problems and risks. Under the pretense of promoting competition, states as diverse as Texas and California, Arkansas and Hawaii have all considered bills that would violate medical device companies’ intellectual property rights. While many have been defeated, some legislators seem intent on advancing one businesses interest over another, which undermines competitive efficiency and, in the case of medical devices, creates risks to patient care. At issue are the rules...

January 31, 2022 Blog

Improving vulnerable populations’ access to medicines is clearly important. But something is amiss when a program that is supposed to improve access to healthcare has turned into a cash cow for hospitals. Yet, that is what has happened to the obscure 340B drug discount program. Too many hospitals across Massachusetts and the US are qualifying for large 340B financial subsidies while not providing greater access to care for the intended population. In Massachusetts, 340B hospitals include some large institutions such as...

January 12, 2022 Briefs, Industry Trends, Price and Costs

BY WAYNE WINEGARDEN AND CELINE BOOKIN Part 1 of the Coverage Denied series documented how distortions in the U.S. healthcare system turned the important financial risk management service of health insurance into a barrier to care and an important driver of health care inflation. The insurance industry’s adverse impact on costs is ironic given its current focus on implementing cost control measures.  Unfortunately, the problems of increasing obstacles to care and decreasing health care affordability are the expected outcomes from the current...