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October 10, 2017 Price and Costs

The U.S. health care system needs systemic reforms that comprehensively address the problems of declining quality and rising costs. Alas, beneficial systemic reforms will not be implemented any time soon. There are still opportunities for Congress to implement tailored reforms that can help address these problems in the near term. One such opportunity is reforming the out-of-control 340B drug pricing program (the federal drug discount program created under the Veterans Health Care Act of 1992). The intent of the 340B program...

September 20, 2017 Price and Costs

Imagine a pharmaceutical market designed by Lewis Carroll’s Mad Hatter. In contrast to almost every other market, he might begin by charging wholesale prices that are higher than retail prices. He would then make sure that the higher wholesale price goes, the lower retail prices can become. And finally, he would ensure that not everyone could purchase their medicines at the low retail prices – although the reason why would be convoluted and random. While we can be certain that the...

September 13, 2017 Policy Proposals

Effective health care reforms must reduce the excessive costs imposed by frivolous lawsuits. Studies have shown that medical tort reform could reduce total health care premiums between 1 and 3 percent. As estimated by the American Action Forum, this could mean “roughly $15 billion” in savings from effective (but partial) medical tort reform. Given the desperate need to bend the health care cost curve, implementing medical tort reforms that rein in over-zealous lawyers should be a no-brainer. But then again, this...

September 11, 2017 Price and Costs

The refrain that pharmaceuticals are driving the health care affordability problem has been repeated so often that it is becoming an illusory truth – people believe it to be true simply because they have heard it repeated so often. Obviously, repeating the same incorrect statement over and over again does not make it so. It does squander valuable time as legislatures continually consider bills with no hope of improving the quality, or reducing the costs, of health care. For instance, California is...

July 26, 2017 Innovation

Disincentives plague the U.S. health care system, driving costs higher and the quality of care lower. Improving health outcomes requires reforms that remove these disincentives. With respect to health insurers, this means returning payers to their proper role of providing effective risk management services to patients. In contrast to other insurance markets, health insurers degrade their ability to cover medical emergencies because they cover the costs of routine expenditures that are not risks in the true sense of the word. If other...

July 21, 2017 Price and Costs

The drama of “repeal and replace” resembled an unfunny version of a Monty Python skit, continuously claiming that it was “not dead yet”, and even that it was “getting better” only to be put out of its misery in the end. The end of repeal and replace will not end the push for health care reform. There are simply too many problems that must be addressed – one way or another. One of these issues gaining traction is the growing push...

June 6, 2017 Policy Proposals

Tweaks do not turn bad regulatory proposals into good ones. Yet, with only minor modifications, Congress is once again considering the CREATES Act (Creating and Restoring Equal Access to Equivalent Samples Act of 2017), and its close cousin, the FAST Act (Fair Access for Safe and Timely Generics Act of 2017). Regulatory analyses quickly become detailed, and, frankly, quite boring. However, as the size and scope of the regulatory burden continues to grow, so does the negative impact on our economic...

May 17, 2017 Policy Proposals

In a unanimous and bipartisan vote, Arizona’s legislature passed the Free Speech in Medicine Act, which was signed into law about two months ago. Passing anything with bipartisan support is noteworthy in today’s hyper-partisan environment. Passing a bill with such important and positive implications for patients, even if the law is more symbolic than meaningful, is remarkable. Perhaps even more remarkable, the U.S. Congress now has an opportunity to replicate Arizona’s success at the federal level via the Medical Product Communications...

May 11, 2017 Value

An obscure institute that most people have never heard of threatens to impose unwarranted restrictions on medically-advised treatments for patients. The Institute for Clinical and Economic Review, or ICER as it is commonly known, assesses whether medicines are cost effective, based on ICER’s definition, of course. These assessments are intended to influence which drugs are made available to patients. From a patient perspective, it is disconcerting that an outside group, which is not an attending doctor, is influencing which FDA approved...

May 9, 2017 Price and Costs

Click here to read PRI's new issue brief, The Economic Costs of Pharmacy Benefit Managers Express Scripts, the largest pharmacy benefit manager (PBM) in the nation, is discovering just how much customer service matters. It may also be discovering that suing your biggest customer in court is generally not considered good customer service. Should Anthem Inc. withdraw its business from Express Scripts as it has indicated, then clearly the largest for-profit health insurance company will have made the determination that the value...

April 27, 2017 Price and Costs

The growing problem of health care affordability requires prompt and effective policy solutions. However, just as the wrong medical diagnosis will not cure a patient, and may make the patient even sicker, the wrong policy solution will not address the U.S. health care affordability problem, and may even worsen the problem. Proposals to import pharmaceuticals from overseas are the wrong policy solution. Nevertheless, both Hillary Clinton and President Trump advocated for drug importation on the campaign trail; and, Senator Bernie Sanders...

April 5, 2017 Value

One of the cornerstones of Great Britain’s National Health Service is an agency that approves and controls access to prescription drugs, the National Institute for Health and Care Excellence. NICE recently announced a new policy that could delay and restrict access to new medicines for British citizens if the agency deems they don’t pass its “budget impact test.” A drug may be approved as safe and effective, but patients could still wait for years to get it if the agency...

March 7, 2017 Price and Costs

Imagine if you never had to directly pay for your morning cup of coffee again. Instead, a coffee insurer guaranteed that, for a small co-pay, you could enjoy a cup of coffee every morning. Sounds good? The catch, and there is always a catch, is the caveat “directly pay.” In this bizarre world, you would still be paying for your cup of coffee every morning, but instead of paying your favorite barista, you would now pay your local coffee insurer. But, bureaucracy loves...

March 2, 2017 Price and Costs

President Donald Trump is not the only politician saying he is going to work to get drug prices down. Oregon lawmakers are already patting themselves on the back for tackling drug prices. Rep. Mitch Greenlick (D-Portland) says the measure, Oregon House Bill 2387, could be a model for national reform. "If we can actually get it done," he recently explained, "it will show the country how to get those costs down." Let's hope he's wrong. The reform he's supporting is nothing...

February 24, 2017 Price and Costs

A recent oped in The Hill by MedShadow Foundation founder Suzanne Robotti claims that permitting Americans to import prescription drugs from Canada would save dollars and lives. It would do neither. Prescription drug importation has several notable proponents, like Sens. John McCain (R-Ariz.), Amy Kobuchar (D-Minn.), and Bernie Sanders (I-Vt.), along with President Donald Trump. Without question, all of them sincerely want to make medicines more affordable. But importation wouldn't save patients much money. Instead, it would hamstring the Food and...

January 10, 2017 Price and Costs

Minnesota Senator Amy Klobuchar just introduced a federal budget amendment that would legalize the importation of foreign prescription drugs. This particular policy change has long topped Democrats' health care wish list, but shockingly, they might find support across the aisle this year, as President-elect Trump has spoken glowingly of importation. The bipartisan support doesn't make the proposal any better an idea. Legalizing importation would expose Americans to substandard foreign pills and undermine domestic drug innovation. Importation proponents say that American patients could...