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.

The wrong model, no matter how hard you work it, will never provide the right answer. When it comes to how we pay for health care, the U.S. is using the wrong model. What’s worse, these financing inadequacies could threaten the viability of new therapies that will bring hope to patients who formerly had none. The well-being, and sometimes the lives of patients, depend on getting the health care financing model correct. New gene therapies will transform the treatment of devastating diseases. For...

Why People with Diabetes Drive for Hours to Buy Insulin in Canada By Christopher Curley For Lija Greenseid, the math was simple. Drive a few hours to pay $56 for a box of Humalog insulin pens for her young daughter with type 1 diabetes or pay as much as $230 at home. The decision, in fact, was a no-brainer for Greenseid and a group of diabetes advocates and patients who made the trek from Minnesota to Canada to buy insulin in early May. That trip...

Sometimes the important reforms are those that address the mundane details. The Administration’s proposed changes to how pharmaceutical rebates are paid fall into this category. While far from a panacea, this reform could meaningfully improve the pharmaceutical market. For this reason, the Congressional Budget Office’s (CBO) just released “budget score“ on the proposal is disconcerting. A budget score from the CBO estimates the impact of policy changes on the federal budget. In this case, the CBO estimates that between 2020 and 2029 the...

The costs of medicines continue to dominate the headlines, attracting the attention of Congress and the Trump Administration. Reforms are necessary, but many of the reforms under consideration will make the situation worse. Indexing U.S. prices to the prices in other countries that use price controls, or using third-party arbitration to set the price of prescription drugs, exemplify these wrong-headed policies. The Trump Administration’s proposal would set Medicare Part B prices (prices for drugs administered in a clinical setting) to the...

Senator Rick Scott (R-FL) has just doubled down on one of the Trump Administration’s unsound ideas. His proposal is disappointing for many reasons, particularly because Alex Azar, Secretary of Health and Human Services, has proposed an alternative reform that, if Congress implemented, would meaningfully improve the affordability of prescription drugs for patients. As part of the “Transparent Drug Pricing Act of 2019”, Senator Scott proposes to set the list price of all medicines to the lowest retail list price among five...

Today’s hearing in front of the Senate Finance Committee will, unfortunately, be another wasted opportunity. Surely, Senators will make grandiose speeches and be shocked at the cost of drugs. They will also continue to support the very policies that are causing the problems the hearing is supposed to address. A February 25th editorial from the New York Times exemplifies why this opportunity for effective reforms may very well be lost. The Senate hearing is not a day of reckoning as the Times claims. It should be an opportunity...

In California, politics is taking precedence over patients. That’s the only conclusion to draw from Gov. Gavin Newsom’s recently released health care plan. He’s looking to impose price controls on prescription drugs. He’d like to expand Medicaid to undocumented immigrants up to the age of 26. He’s called for re-imposing the individual mandate, which would require everyone in the state to obtain coverage. He wants to subsidize the purchase of health insurance for those making up to six times the poverty...

This year, 1.7 million Americans will be diagnosed with cancer. For over 600,000 of them, that diagnosis will prove fatal. But there’s hope on the horizon. More Americans are surviving cancer each year, according to a new study from the American Cancer Society. The cancer death rate declined precipitously between its peak in 1991 and 2016. Absent that decline, 2.6 million more cancer patients would have died during that period. By one estimate, 73% of recent survival gains are due to...

*Featured in Kaiser Health News Morning Briefing* Today, Type 1 diabetes patients pay twice as much for insulin as they did in 2012. This is outrageous — but drug companies aren’t to blame. The problem is a dysfunctional supply chain that benefits everyone except patients. In today’s system, insurers hire third-party firms, known as pharmacy benefit managers, to manage drug plans. These PBMs negotiate with drugmakers and have the power to decide which drugs are covered by each plan. Each year, manufacturers dole out $150...

In response to the problem of rising list prices for drugs, elected officials continue to propose counterproductive reforms. Whether it is importing drugs from Canada or indexing U.S. drug prices to the prices charged in other countries, these policies will make the current bad situation worse because they fail to understand the disincentives that are the root cause of the problem. Until now. A proposal by Health and Human Services Secretary Alex Azar, if implemented, would meaningfully improve the pharmaceutical market. The...

Health and Human Services Secretary Alex Azar just released a sweeping proposal that would drastically change how Medicare pays for advanced cancer therapies and other potent medicines. The plan relies on foreign price controls to reduce drug spending by $17 billion over five years. Although drug spending may decline, the plan could increase health care spending elsewhere, as patients inevitably lose access to medicines. So while the savings is questionable, the negative health impact on patients is certain. Sec. Azar ought...

Congress is poised to consider a bill that would allow Americans to import prescription drugs from Canada. The bill’s authors, Sens. Chuck Grassley (R-Iowa) and Amy Klobuchar (D-Minn.), label their effort as a bipartisan push to “help Americans who struggle to pay exorbitant prices for medication.” It’s noble of lawmakers to tackle prescription drug costs. Eight in ten Americans are concerned about the price of medicines, according to a Kaiser Family Foundation survey. But the Grassley-Klobuchar bill isn’t the right solution. While it...

By Henry I. Miller, M.S., M.D. and Jeff Stier Trump administration officials keep searching for solutions to rising prescription drug prices, which are increasing faster than inflation. "Drug makers and companies are not living up to their commitments on pricing. Not being fair to the consumer, or to our Country!" President Trump tweeted on Jan. 5. Most of the administration's suggested remedies have been threats or the imposition of various types of price controls. On Thursday, Jan. 31, Department of Health and...

In mid-January, three Democrats — Vermont Sen. Bernie Sanders, Maryland Rep. Elijah Cummings, and California Rep. Ro Khanna — introduced legislation that aims to reduce prescription drug prices. Their plan would essentially peg U.S. drug prices to those in five foreign countries where prices are typically lower because their governments forcibly control them. It would also open our borders to imported drugs from Canada and other countries. Their proposal is painfully shortsighted. It would slow pharmaceutical innovation and expose patients to dangerous counterfeits in...

President Donald Trump and Sen. Bernie Sanders don’t agree on much. But they both believe in price controls. Both men recently introduced separate proposals to impose price controls on prescription drugs. Though both men are likely well-intentioned, their plans are deeply misguided. Both proposals would discourage drug research and reduce access to medicines. The Trump administration’s proposed rule, released this fall by Health and Human Services Secretary Alex Azar, would change the way Medicare pays for most cancer drugs and other medicines...

In one of his first acts, Governor Newsom signed an executive order that will change how medicines are purchased in California. With visions of big-box store discounts dancing in his head, Governor Newsom has established a bulk program that will now purchase drugs for the state’s Medicaid program (Medi-Cal). The Governor believes that his executive order will create significant health care savings for the state, but he will be sorely disappointed. Imposing more government mandates and increasing bureaucratic control of the...

On Dec. 18, Sen. Elizabeth Warren, D-Mass., introduced the Affordable Drug Manufacturing Act. The bill would create an Office of Drug Manufacturing to produce and sell generic medications. Warren hopes this government entity would solve "market failures" — her term for generic drug shortages and steep price hikes on off-patent medicines. The plan is absurd. The federal government has no business operating a drug manufacturer. If federal officials want to expand access to generic drugs (a worthy goal) they should harness the power of free markets. Within...

Despite the constant barrage of negative news, this is an exciting time for patients. Truly innovative medicines and gene therapies are under development. New gene therapies are particularly exciting because these therapies do not just treat diseases – they often cure them by fixing underlying genetic defects, frequently with only one dose. There is great optimism that these fundamentally new therapies will, ultimately, cure diseases like hemophilia and sickle cell disease, and even many ultra-rare diseases that were previously untreatable. Take...

There is no shortage of bad ideas when it comes to the pharmaceutical market. One such proposal would allow drugs to be imported directly from other countries, such as Canada. Then there is the Trump Administration’s proposal that would effectively adopt foreign price controls on Medicare Part B drugs by implementing an international pricing index (IPI). These policies, if implemented, would harm the quality of health care in the U.S. by reducing patients’ access to medicines and harming future innovations. What’s...