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.

Earlier this year, European authorities recommended approval of tofersen, a new drug that treats a rare genetic form of amyotrophic lateral sclerosis, or ALS. That decision came nearly a year after American regulators granted the drug accelerated approval. Patients with that rare form of ALS in England aren't so lucky. The National Institute for Health and Care Excellence, or NICE, which evaluates whether treatments are "cost-effective" for the country's National Health Service, announced a decision in March that would effectively render the drug unavailable to them. It's a...

Last month at a White House event, President Joe Biden and Sen. Bernie Sanders, I-Vt., took a victory lap for supposedly having "beat Big Pharma" through drug-pricing provisions in the Inflation Reduction Act. Beaming with pride, they hailed new powers for Medicare to "negotiate" drug prices as a historic achievement. But their self-congratulation rests on a false premise. Far from being a big win for Americans' health, the IRA bankrolls billions of dollars' worth of left-wing policy priorities at the expense of life-saving pharmaceutical innovation...

Speaking at a White House event with Sen. Bernie Sanders, I-Vt., very recently, President Biden crowed about his rapidly progressing scheme to impose price controls on prescription drugs. "Finally — finally we beat Big Pharma," he said to Sanders. Unfortunately for Americans — and indeed, patients everywhere — the Democrats' assault on the drug industry will result in fewer cures, less access to state-of-the-art medicines, and more avoidable death and suffering. Democrats gave the federal government the ability to dictate the prices of prescription drugs through Medicare...

Barber et al. just published a fundamentally flawed study on diabetes medicines in JAMA Network Open (JNO). This study wrongly suggests that cost-based pricing accurately values innovative on-patent medicines, distracts from serious policymaking, and fuels political grandstanding by politicians such as Senator Bernie Sanders. Cost-based pricing could be an economically viable pricing strategy for generic drugs. Mark Cuban’s Cost Plus Drugs (CPD), launched in 2022, is attempting to disrupt the generics industry using this pricing model. CPD sells generic medicines directly to consumers...

Like most pharmaceutical companies, Gilead Sciences Inc. devotes a huge amount of time and money to making sure its products are safe for patients. The U.S. Food and Drug Administration approved its drugs to fight HIV, and these medications have worked remarkably well. It then developed the next generation of HIV medications, and those too have worked well. For that, Gilead is being rewarded with lawsuits—lots of them. Earlier this year, California's First District Court of Appeal ruled that lawsuits brought by...

Vermont Senator Bernie Sanders called the CEOs of several major pharmaceutical firms to testify earlier this month before the Senate Health, Education, Labor and Pensions Committee, where he serves as chairman. The hearing's official purpose was to discuss prescription drug pricing. But it mainly offered Sanders a forum to castigate the pharmaceutical industry. "The overwhelming beneficiary of high drug prices in America is the pharmaceutical industry," Sanders said. "The United States government does not regulate drug companies. With a few exceptions, the drug companies regulate...

The Left has long insisted that medical debt is a national crisis and that the federal government needs to do something about it. They appear to have new ammunition in the form of an analysis published this month by the Peterson Center on Healthcare and KFF. Nearly one in 12 adults — 20.4 million people — had medical debt in 2021, according to the brief. But a closer look at the numbers shows that these figures rely on some questionable assumptions. The Peterson-KFF study counts any adult with “over $250 in unpaid medical bills as...

By Sally Pipes & Wayne Winegarden There they go again. Free-market advocates are jeopardizing pro-market healthcare reforms based on an inability to recognize how cronyism tars the current industry dynamics. That distinction between companies operating in a free market and companies using cronyism to flourish in a government-dominated market is the key. At question are the operations of pharmacy benefit managers (PBMs). PBMs serve large insurers, employer-sponsored health plans, and government health plans. The three largest PBMs control nearly 80% of the...

The price of health insurance has skyrocketed in recent years, according to a new report from the Kaiser Family Foundation. Average annual premiums for employer-based family plans have risen by 22% percent since 2018, to nearly $24,000. It's tempting to see these hikes as a shameless cash-grab by avaricious insurers. But there are more systemic factors fueling the growth of health costs. Only by attacking these root causes can policymakers bring down the cost of coverage without compromising the quality of...

Last year’s Inflation Reduction Act is not proving popular with a group it aims to help — older Americans. That’s according to a recent survey from Commitment to Seniors. More than 80% of likely voters over 55 believe the IRA hasn’t helped them personally in terms of lowering the impact of inflation, consumer costs, and prescription drug prices. Almost eight in ten say the IRA is a failure one year after its passage....

There's a paradox at the center of American healthcare policy. The government will spend just shy of $2 trillion subsidizing healthcare this year — including over $500 billion on Medicaid and the Children's Health Insurance Program. But low-income Americans still struggle to afford care. According to one recent poll by the Kaiser Family Foundation, nearly seven in ten Americans earning less than $40,000 a year find it at least somewhat difficult to pay for healthcare. Read the full article at Newsmax...

The pharmaceutical supply chain is rife with misaligned incentives. Due to these disincentives, policies that make sense under most market conditions create problems that harm patients. Coupling the fees of pharmacy benefit managers (PBMs) to the discounts they negotiate exemplifies this problem. Read the full article by Sally Pipes and Wayne Winegarden at Forbes.com...

The Biden administration recently announced the first 10 drugs that will be subject to price controls under Medicare as part of the Inflation Reduction Act. The president celebrated the occasion, saying, "We took on Big Pharma and special interests, overcoming opposition from every Republican in Congress, and the American people won." "Won?" The next generation of American patients will not feel like they "won" when they're stuck waiting even longer for effective treatments -- if those treatments ever materialize. Read the full...

A government shutdown has been averted—for now. Congress approved a continuing resolution this weekend that funds the government through mid-November. But the weeks-long fight put other important legislative work on hold. Take the “Lower Costs, More Transparency Act.” Late last month, lawmakers pulled it from the floor ahead of an expected vote. The sponsors of the bipartisan bill—whose name is an apt summary of its goal—did so after a whip count revealed they would not have enough votes to pass it. Whatever...

The House Committee on Oversight and Accountability met last week for a hearing on the Inflation Reduction Act's first year. As one of the witnesses pointed out, the law's implementation — particularly its drug pricing reforms — have already run afoul of some of our government's most basic norms of transparency and accountability. The IRA gives federal officials the authority to dictate what Medicare pays for certain medicines — a scheme intended to reduce the government's drug bill. Late last month,...

Members of Congress on both sides of the aisle are examining how industry middlemen known as Pharmacy Benefit Managers (PBMs) are driving up healthcare costs. Rightly so. PBMs have been manipulating the complex and opaque drug pricing system at the expense of patients for far too long and Congress must act. Read the full article by Sally Pipes and Wayne Winegarden at RealClearHealth...

President Joe Biden celebrated a milestone today—but American patients have no reason to cheer. The White House announced the first 10 prescription drugs that, starting in 2026, will be subject to price controls authorized by the Inflation Reduction Act. Democrats laud these price controls, which they glibly dub "negotiations," as a way to lower drug costs for seniors on Medicare. But in the not-too-distant future, people of all ages may look back and rue this day—as the beginning of the end of...

The Biden administration claims to support price transparency in healthcare. The Centers for Medicare and Medicaid Services has formally warned hundreds of hospitals to comply with federal rules requiring them to post their prices publicly. And the agency just rolled out a new rule designed to “advance prescription drug transparency in Medicaid.” But that drug pricing rule has little to do with transparency. It’s an opaque bid by the White House to impose price controls on drug makers. If implemented, it...

Who says bipartisanship is dead? In the House and Senate, members of both parties are advancing legislation to check the power of pharmacy benefit managers (PBMs), the self-dealing middlemen in the drug supply chain that inflate Americans' spending on prescriptions by billions of dollars a year. By shining a light on PBMs' questionable business practices, and potentially cracking down on some of their anticompetitive behavior, lawmakers can help patients fill their prescriptions without breaking the bank....

The last few months have seen a flurry of activity on Capitol Hill regarding prescription drug reform, with a particular focus on pharmacy benefit managers, or PBMs. The U.S. Senate Finance Committee is set to markup a bipartisan PBM reform bill within the next few days. The House Energy and Commerce Committee and the House Committee on Education and the Workforce are weighing PBM reform legislation of their own. All these efforts have an eye on reducing drug costs for patients. Click to read the full article in...