Price and Costs

On this page, you’ll find the Center’s research on the complex world of pharmaceutical pricing. Our focus will be breaking down current pharmaceutical pricing structures and processes and potential reforms to improve efficiency and innovation; evaluating the impact of regulatory-created inefficiencies such as Pharmacy Benefit Managers (PBMs) and the 340B program; and analyzing how policy proposals such as price controls and drug importation would undermine competition.

A group of 25 senators, led by Sen. Elizabeth Warren (D-MA), requested that HHS Sec. Xavier Becerra exercise march-in rights for Xtandi (enzalutamide), a prostate cancer therapeutic. March-in rights give the government the right to take a license for itself if it helped to fund the product owner's research . . . “Net prices, which take into account discounts and rebates, have been going down for several years,” Wayne Winegarden, Ph.D., senior fellow, business and economics, Pacific Research Institute, told BioSpace. “Gross...

Democrats remain fixated on prescription drug prices. Last August, they managed to include price controls on drugs dispensed through Medicare in the Inflation Reduction Act. And they're not done meddling. Earlier this month, Rep. Lloyd Doggett, D-Texas, called on President Biden to unilaterally suspend drug patents in order "to address the crisis of unaffordable medicines." Socialist Sen. Bernie Sanders, I-Vt., has named drug pricing as one of his top legislative priorities in his new role as chairman of the Senate Health, Education, Labor, and Pensions Committee....

Shopping around has never been easier. With a few clicks, consumers can easily find deals on flights, get multiple quotes on car insurance or price-match items in their local shopping mall. Yet when it comes to spending money on something really important — their health — consumers are largely in the dark. Federal rules that took effect last year were supposed to address this problem by requiring hospitals to publish the prices of 300 common services. The goal was to make health...

On Dec. 14, the Centers for Medicare and Medicaid Services (cms.gov) released their latest estimate of the country's annual healthcare tab. For the second straight year, U.S. healthcare spending topped $4 trillion. In 2021, health spending accounted for more than 18% of U.S. GDP. Progressives tend to cite numbers like these when making their case for greater government involvement in healthcare — or even a government takeover of the health insurance system, a la Medicare for All....

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...

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...

Hospitals aren't complying with a nearly 2-year-old federal rule requiring them to publish their prices, according to new research from PatientRightsAdvocate.org. Their willingness to flout the law is understandable. They make more money when people don't know how much the medical services they consume cost. But patients and payers shouldn't stand for this intransigence. It's depriving us of information we could use to foster competition among healthcare providers — and ultimately secure better care at a lower cost....

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...

Democrats are riding high on the public support they’ve garnered for passing legislation giving Medicare the power to negotiate for lower prices from drug makers. A Politico-Morning Consult Poll found that 76% of Americans support price caps on drugs, while only 13% do not.   In other words, Democrats have effectively convinced the public that government-controlled drug prices will deliver better, more affordable care.   But that’s incorrect. The drug-price provisions within the Inflation Reduction Act will reduce the number of new drugs that...

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...

Democrats have nudged the U.S. healthcare system closer to Canadian-style socialism with their recently signed, and dubiously named, Inflation Reduction Act. The IRA will impose a collection of price caps on prescription drugs. Canada has long forcibly controlled drug prices—and thereby deprived patients of access to cutting-edge care. The story will be the same in the United States, unless a future Congress and president roll back the IRA's price controls before they take effect in 2026. Among the IRA's suite of price...

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,...

Progressives claim that medical debt leads to financial ruin for hundreds of thousands of Americans each year. Sen. Bernie Sanders, I-Vt., recently argued that the high cost of health care is pushing so many people into bankruptcy that the government must cancel medical debt. It's the precursor to his call for a federal takeover of the entire health insurance system so that no one has to pay for medical care directly again. Medical bills can be onerous. But they account for a...

Some Illinois hospitals are keeping their prices secret from their patients. Only three out of a sample of 11 major medical facilities in the state are fully compliant with a federal rule requiring hospitals to publish the costs of common services, according to data from the nonprofit group PatientsRightsAdvocate.org. That includes hospitals in Chicago. Hospitals shouldn’t be able to get away with flouting the law like this. Price transparency empowers patients and payers to shop around for medical care — and ultimately...

The Democrats' budget reconciliation bill is winding its way through the Senate. Last week, Republican and Democratic senators met with the chamber's parliamentarian to discuss whether the bill's proposal for Medicare to negotiate the price of prescription drugs with manufacturers has a direct impact on government spending or tax revenue, as reconciliation rules require. But these are not negotiations. They're price controls. The bill's text sets maximum prices that the government will pay — and threatens confiscatory taxes for drug companies that refuse to...

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...

With inflation rising and midterm elections just months away, Democrats are desperate for something they can pitch to voters as a reason to keep them in control of Congress. They're hoping a watered-down version of their Build Back Better Act could do the trick. Sen. Joe Manchin, D-W. Va., who helped shoot the bill down last winter, has met repeatedly with Senate Majority Leader Charles Schumer, D-N.Y., in recent weeks in an effort to hash out a compromise on the massive spending package. Reports indicate a proposal to...

Hospitals are shoring up their balance sheets on the backs of cancer patients, according to a new study published in JAMA Internal Medicine. Researchers looked at 25 of the top cancer medications distributed at 61 cancer treatment centers across the country over the course of six months. They found that the clinics charged private insurers anywhere from 118% to 634% above what it cost them to acquire the drug. It shouldn’t take a team of medical researchers to find out how much...

More than eight in 10 hospitals are flouting a federal rule requiring them to publish their prices, according to a new report. That rule has been in force for over a year now. It’s long past time for hospitals to comply. The lack of transparency in the health care market is costing patients billions of dollars. Since Jan. 1, 2021, the Centers for Medicare and Medicaid Services have mandated that hospitals share how much they charge for at least 300 different “shoppable...