Industry Trends

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...

Last week, on Dec. 19 specifically, Sen. Joe Manchin, D-W.Va., announced that he would not support the current iteration of the Build Back Better Act. His decision calls the future of the $1.75 trillion spending package into serious question. For this, Democrats have only themselves to blame. After all, Manchin's demands that Democrats scale back their ambitions are more than reasonable — especially at a moment of high inflation and economic uncertainty. Build Back Better employs a host of gimmicks to mask the bill's true cost. Indeed,...

Even health care answers to the law of supply and demand. Before the pandemic, demand for care was surging as our nation aged. Supply has not kept up. More than 83 million Americans live in areas where there’s a shortage of primary care health professionals, according to the federal government. Rising demand coupled with limited supply is a recipe for high prices. And now, with a new variant of covid-19 in our midst, demand for care will only increase. Relaxing the laws that limit what...

Last week, President Joe Biden emphasized the importance of the drug pricing proposals in the Democrats' roughly $2 trillion Build Back Better spending package. "I think it's safe to say that all of us, all of us, whatever our age, wherever we live, we can agree that prescription drugs are outrageously expensive in this country," Biden said. "Under my Build Back Better bill, which has passed the House of Representatives, it won't be the same way." Build Back Better would make significant changes to drug pricing...

Earlier this month, President Joe Biden unveiled a plan to make at-home COVID-19 tests free for people with private insurance. They'll have to pay for the tests first, then submit receipts to their insurer to get reimbursed. Only the government could come up with a plan so unnecessarily complicated. The Biden administration defended the overly bureaucratic policy on the grounds of cost. But bureaucracy is one of the main reasons at-home tests have been so difficult to find in the first place. As...

The Center for Biosimilars® interviewed Wayne Winegarden, PhD, senior fellow in business and economics at Pacific Research Institute (PRI) and director of PRI’s Center for Medical Economics and Innovation. Winegarden said that because of the high costs associated with Humira (reference adalimumab) and Enbrel (reference etanercept), biosimilars of these agents are needed to establish a competitive marketplace and to drive down costs. He said the long exclusivity periods that the makers of Humira and Enbrel have secured must end to allow greater affordability;...

Several hospitals in New Mexico activated crisis standards of care last month in response to a surge in COVID-19 patients. Earlier this fall, Alaska and Idaho did the same. In some places, providers were forced to begin rationing treatment based on the likelihood of survival. It was a shocking spectacle for many Americans, accustomed as we are to hospitals with enough beds, equipment, and doctors to go around. It only took 22 months of an unprecedented pandemic for the healthcare system in...

Earlier this month, President Biden tapped Dr. Robert Califf to lead the Food and Drug Administration. The agency had been operating without a Senate-approved commissioner for almost a year. In my last column, I detailed how the FDA's failures reviewing and approving tests for COVID-19 have prolonged the pandemic. This week, we have a new source of dysfunction to explore—the FDA's foot-dragging on antiviral pills that treat COVID-19 and booster shots. Americans are needlessly suffering—and dying—because of that dysfunction. Since President Biden took office, FDA veteran...

By Wayne Winegarden and Celine Bookin Billionaire investor Mark Cuban’s pharmaceutical company, the Mark Cuban Cost Plus Drug Company, is hoping to disrupt the pharmaceutical benefit management (PBM) industry with a new venture that seeks to address some of the most criticized practices of the industry. These include PBMs pocketing rather than passing on negotiated rebates and not being transparent in how they negotiate said rebates. PBMs traditionally contract with governments and businesses to manage drug formularies, determine co-pays, administer plans, and negotiate...

DOWLOAD THE PDF In October 2019, the Center for Medical Economics and Innovation at the Pacific Research Institute released its second study documenting the savings potential enabled by biosimilars. Biosimilars are medicines manufactured in, or derived from, biological sources that are developed to be similar to FDA-approved reference products. Biosimilars are approved to compete in nine biologic drug classes in the U.S. and are available in seven of these drug classes currently.  Since 2018, biosimilars’ market share has grown appreciably, see Figure...

A record 5.6 million patients in the United Kingdom are currently on waiting lists for hospital care. That's equivalent to nearly one in 10 Britons. Of that group, about 300,000 have been waiting at least one year for treatment. Those who can afford to are increasingly paying out of pocket for private care. More than 20% of British residents are doing so, according to recent polling. Britain's National Health Service has long been a source of pride for the country. The organizers of the 2012 London Olympics made the NHS...

The delta variant has wreaked havoc. This week, the U.S. reported a seven-day average of more than 146,000 daily cases . In total, COVID-19 has killed more than 660,000 Americans since the start of the pandemic. Thankfully, the rate of increase appears to be falling in many areas, compared to the surges in July and August. But significant damage has already been done. Much of this carnage could have been avoided if the Food and Drug Administration had accelerated approvals of...

The Congressional Budget Office just released an analysis of House Democrats' effort to impose price controls on prescription drugs, H.R. 3 -- the Elijah E. Cummings Lower Drug Costs Now Act. The CBO's chief finding is grim. By drastically limiting pharmaceutical revenue, H.R. 3 would starve scientists of the funding they need to research and develop new medicines. The result is that dozens of treatments and cures -- therapies that could save and enhance people's lives -- would never be invented. In other words, Democrats are...

President Joe Biden has finally figured out how to get Americans onto the Obamacare exchanges — by paying them. The administration recently congratulated itself after 2.5 million Americans signed up for plans through the government-run marketplaces during a newly created Special Enrollment Period that closed August 15. But these figures don't reflect newfound enthusiasm for Obamacare. The numbers are the result of more generous federal subsidies enacted in April as part of the American Rescue Plan Act. Through next year, those who make more than 400% of the poverty level, or...

Medical devices are something of an orphan sister to the glamour of drugs, but they include some of the genuine miracles of modern medicine, particularly for seniors: Pacemakers, artificial joints, insulin pumps, and CT, MRI, and radiotherapy machines are just a few examples. The United States is currently the global leader in medical device innovation, and it is one of the few major industries that both boasts a net trade surplus and is a job creator. The sector employs 400,000...

The Senate is poised, on Tuesday, to pass a $1 trillion bipartisan infrastructure package. According to the latest estimate from the Congressional Budget Office, the new spending will increase the deficit by over $250 billion. The 2,700-page bill appropriates an avalanche of funding for everything from electric vehicle charging stations to public transit systems. It also includes a "Buy American" provision that requires government agencies to purchase masks, gloves, and other personal protective equipment from domestic companies. Such protectionist policies are...

Demonstrators in 50 cities across the country took the streets last month to demand a government takeover of America's health system. The Democrats who control Washington are trying to give those activists what they're asking for, albeit in piecemeal fashion. In recent weeks, they've proposed lowering Medicare's eligibility age and adding dental, vision and hearing benefits to the entitlement. Democrats in Congress have also offered a plan to provide federally funded health coverage to low-income people in the 12 states that have yet to adopt Obamacare's Medicaid expansion. This drive to...

Millions of people have canceled doctor’s appointments and postponed elective surgeries over the past 18 months. But now that the pandemic has largely subsided, many patients feel it’s once again safe to seek care. A Gallup poll conducted in May found that nearly 17% of Americans had gone to a hospital, doctor’s office, or treatment center in the previous 24 hours, up from just 6% the year before. Whether patients actually receive the care they’re seeking, though, depends entirely on where they...

Dr. Henry Miller talks about potential life-saving medical technology with organ transplants on the nationally-syndicated Lars Larson Show. Dr. Miller talks about advances in 3-D printing for liver, gallbladder, and even heart transplants and why the FDA is slow to test and approve these groundbreaking practices. Dr. Miller's segment begins at the 48-minute mark. Lars Larson National Podcast · Lars Larson National Podcast 06-22-21...