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June 19, 2023 Issues, Price and Costs

Pharmaceutical giant Merck announced last week that it is taking the federal government to court over the Inflation Reduction Act's drug pricing reforms. The lawsuit alleges that the law's Medicare price negotiation program violates some of the most fundamental rights guaranteed by the U.S. Constitution. "This is not 'negotiation,'" the company says in its official complaint. "It is tantamount to extortion." Such strong language is justified. The IRA's price controls represent an unprecedented act of government intervention into the prescription drug market — one that...

June 4, 2023 Innovation, Issues

Patients in several states could soon find it easier to access life-saving medical care, if state legislators and executive officials eliminate so-called certificate-of-need restrictions for new acute-care hospitals in rural areas. Certificate-of-need laws require health care providers to get a state government’s sign-off before building new facilities, expanding existing ones, or even purchasing new equipment. These laws are currently on the books in nearly three dozen states. It makes little sense to artificially restrict the supply of medical care when our nation...

May 22, 2023 Issues, Policy Proposals

America is facing a chronic doctor shortage. Solving that problem will require not just more doctors but a much bigger role for advanced-practice nurses in our healthcare system. A 2021 report found that the United States will need nearly as many as 48,000 more primary care doctors by 2034 to meet patient demand. It’s infeasible to train that many more new doctors over the next decade. We need to make better use of the supply of healthcare professionals we have. In nearly...

May 22, 2023 Innovation, Issues

New research into COVID-19 has revealed some troubling findings. Even mild cases can lead to lasting heart complications. Comparing test data collected before and after a group of patients in their mid-30s contracted mild cases of COVID, researchers noticed an increase in arterial stiffness and cardiovascular inflammation. That means they may face "a widespread and long-lasting pathological process" that places them at elevated risk of cardiovascular issues. Heart disease is already America's leading cause of death, claiming roughly 700,000 lives per year. Add to that potentially increased risk...

May 21, 2023 Coronavirus, Issues

The price of a COVID-19 shot will soon go up. The federal public health emergency ended this month, and the government will stop providing COVID vaccines to all Americans free of charge. Moderna and Pfizer have both signaled that they plan to raise the prices of their shots once the vaccines move to the commercial market. And that's prompted outrage from some of the drug companies' typical foes. Vermont Senator Bernie Sanders castigated Moderna CEO Stéphane Bancel at a recent hearing...

May 10, 2023 Issues, Price and Costs

Today , Sen. Bernie Sanders, I-Vt., will haul executives from three insulin manufacturers and three pharmacy benefit managers before the Senate Health, Education, Labor and Pensions Committee for a hearing on "the need to make insulin affordable for all Americans." Sen. Sanders is sure to call the pharmaceutical executives — who represent Eli Lilly and Company, Novo Nordisk, and Sanofi — greedy, as he has repeatedly during his tenure atop the HELP Committee. This time, though, PBMs will get some heat, too. Good....

May 9, 2023 Issues, Policy Proposals

President Biden’s Inflation Reduction Act is just eight months old. It hasn’t yet slayed inflation. But it’s already gutting drug research and development. The law gives Medicare the power to impose price controls on certain prescription drugs for the first time. By September, federal officials will select the first 10 medicines subject to price-setting from those covered by the Medicare Part D prescription drug program. The price caps for these drugs will go into effect in January 2026. In the months leading...

May 8, 2023 Issues, Price and Costs

The Biden administration is in the midst of setting the terms for its program of price controls on prescription drugs dispensed through Medicare. The first 10 medicines subject to the price caps will be selected by the end of this year. That prospect is already chilling investment in drug research, particularly in small-molecule drugs. This category of medicines, which are generally chemically synthesized, includes everything from aspirin to certain cancer drugs. The implications of this slowdown in research and development could be...

May 5, 2023 Issues, Price and Costs

The Biden administration is cracking down on hospitals that keep their prices secret. Under a policy announced last week, failing to abide by Trump-era hospital price transparency rules will no longer prompt a warning letter from the Centers for Medicare and Medicaid Services. Instead, hospitals will have 45 days to submit a Corrective Action Plan for meeting these requirements — or face a fine. It seems that not even Democrats can quarrel with former President Trump's price-transparency reforms — nor should they. For healthcare...

April 3, 2023 Issues, Price and Costs

Pharmacy benefit managers are in the congressional hot seat. Last Thursday, the Senate Finance Committee held a hearing examining the middlemen's impact on patients. Earlier in March, the House Committee on Oversight and Accountability launched an investigation into PBM tactics that are "harming patient care and increasing costs for consumers." The focus on pharmacy benefit managers is warranted. They game the healthcare system to line their own pockets at the expense of patients. PBMs manage prescription drug benefits on behalf of insurers....

March 23, 2023 Issues, Price and Costs

Despite the rancor, there are many bipartisan opportunities for the divided 118th Congress. Near the top of the to-do list should be reforming the well-intentioned, but poorly designed, 340B drug discount program. 340B enables qualifying institutions to purchase medicines from manufacturers at steep discounts, generally between 25% and 50% off list price, but sometimes even larger. These discounts are supposed to improve the capacity of the clinics and hospitals serving a disproportionate share of low-income and uninsured patients. More and more, this...

March 21, 2023 Innovation, Issues

Sen. Bernie Sanders, I-Vt., has summoned Moderna CEO Stéphane Bancel to Capitol Hill for a public chastising next week. The hearing will probe why the biotech firm would consider raising the price of its COVID-19 vaccine. Since the federal government played some role in the vaccine's development, Sen. Sanders argues, it shouldn't have the freedom to price its product at a price willing buyers will pay if that price strikes the Vermont senator as too high. We should expect nothing less from the...

March 19, 2023 Issues, Price and Costs

Imagine receiving a bill for $10,000. It’s from your local hospital, where you had a minor procedure. But you have no idea why it’s so high, or how you’re going to pay. If you’ve ever had an experience like this, you’re not alone. In 2020, a California couple was billed $80,000 for their twins’ stay in intensive care. In 2022, a South Carolina hospital charged a woman more than $5,000 for a breast biopsy, after refusing to give her a price...

March 15, 2023 Issues, Price and Costs

It's been more than two years since a rule promulgated during the Trump administration requiring hospitals to disclose their prices took effect. Yet according to a new study, most hospitals aren't complying. The analysis, published in January in the Journal of General Internal Medicine, found that just 19% of hospitals examined fully comply with the rule. Hospitals in Tennessee haven't performed any better. A month after the new rule took effect in January 2021, a Vanderbilt University review of the 88 short-term acute care...

March 14, 2023 Issues, Price and Costs

The Inflation Reduction Act’s (IRA) drug pricing provisions will severely curtail life-science research. The IRA vests the Centers for Medicare & Medicaid Services with the power to impose price controls on an ever-expanding list of drugs. The direct result will be that seniors today — as well as future generations of patients — will lose out on access to life-saving cures because those treatments will never be developed. Until the political balance in Washington changes and this deadly folly can be repealed,...

March 13, 2023 Issues, Policy Proposals

What's the difference between getting an x-ray at the hospital and getting one at the doctor's office? The former could cost a lot more than the latter. Medicare often reimburses hospitals more than it pays doctor's offices for the same procedure. Hospitals claim these payment differentials are necessary because they are subject to more extensive regulatory requirements and face other fees; higher payments offset those costs. In reality, these uneven payments simply incentivize the most wasteful and monopolistic tendencies in American health care. Click to read...

March 6, 2023 Innovation, Issues

Experts from the Department of Justice, the Federal Trade Commission , and the American Medical Association just released a paper urging Congress to peel back the Affordable Care Act's restrictions on creating and expanding physician-owned hospitals. Their analysis is correct. Such hospitals inject much-needed competition into the healthcare market. Consequently, repealing restrictions on them could help lower healthcare costs and expand access to healthcare. The 2010 Affordable Care Act bans physician-owned hospitals from expanding and prevents new ones from participating in Medicare or Medicaid. Proponents of this ban...

February 18, 2023 Issues, Price and Costs

President Biden hit the road last week to castigate Republicans for supposedly proposing to make healthcare more expensive. The president is upset that Republicans want to undo the innovation-destroying price controls on prescription drugs included in Democrats’ Inflation Reduction Act and rein in the billions of dollars in subsidies he’s handing out to prop up Obamacare’s exchanges. He’s conveniently ignoring some of Republicans’ own ideas for making health insurance more affordable. In a recent opinion piece, Rep. Michael Burgess, R-Texas — a member of the...

February 15, 2023 Issues, Policy Proposals

Should the government put a price on human life? The new head of the House Energy and Commerce Committee, Rep. Cathy McMorris Rodgers, R-Wash., doesn't think so. She recently introduced legislation alongside several of her colleagues to ban the use of "quality-adjusted life years," or QALYs, in federal healthcare programs. A QALY purports to measure the value of one additional year of life. A QALY of one is equivalent to one year of life in perfect health. A value of zero is death. Economists sometimes try to...

February 8, 2023 Issues, Price and Costs

Last night's State of the Union address was a festival of cognitive dissonance. President Biden proudly lauded the price controls that Democrats have begun implementing on prescription drugs as part of last August's Inflation Reduction Act. He also touted his administration's Cancer Moonshot, which aims to halve the cancer death rate over the next 25 years. These policies are in direct conflict with one another. Pharmaceutical companies are already responding to the IRA's looming price controls by scaling back their research and development efforts....