Price and Costs

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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.

October 3, 2022 Issues, Price and Costs

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...

August 29, 2022 Issues, Price and Costs

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...

August 22, 2022 Briefs, Industry Trends, Price and Costs, Studies

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,...

July 29, 2022 Issues, Price and Costs

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...

July 28, 2022 Issues, Price and Costs

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...

July 26, 2022 Issues, Price and Costs

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...

July 25, 2022 Briefs, Price and Costs, Studies

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...

July 5, 2022 Issues, Price and Costs

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...

May 23, 2022 Issues, Price and Costs

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...

May 19, 2022 Issues, Price and Costs

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...

May 2, 2022 Issues, Price and Costs, Radio, Resources

Listen to the author of a new study discuss how America’s broken third-party healthcare payment system prioritizes government and insurance companies as the largest payers, leaving patients with higher out-of-pocket costs, greater exposure to healthcare financial risk, and reduced access to care.  To learn more, read the "Coverage Denied" series from PRI's Center for Medical Economics and Innovation. ...

April 28, 2022 Briefs, Price and Costs, Studies

America’s broken third-party healthcare payment system prioritizes government and insurance companies as the largest payers, leaving patients with higher out-of-pocket costs, greater exposure to healthcare financial risk, and reduced access to care - finds the latest paper in the Coverage Denied series released today by the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute. Click here to read the brief “The healthcare marketplace should prioritize the needs of patients, but our broken third-party payment system caters to insurers...

April 20, 2022 Issues, Price and Costs

Sustainably addressing the problems of rising prices and declining quality requires reforms that empower patients and doctors, improve price transparency, and eliminate the perverse incentives of our current health insurance system that drive up costs and limit care. Instead of addressing the health care system’s core deficiencies, policymakers push for counterproductive policies like price controls. Efforts in Indiana show that politicians do not need to pass legislation to implement bad ideas. The threat of legislation is sufficient. Indiana’s Senate President Pro Tempore...

March 14, 2022 Issues, Price and Costs

As President Biden's recent State of the Union address made clear, drug pricing will remain a top policy issue for the foreseeable future. The president is correct that something must be done, but his proposals are wrongheaded and will only make things worse. Instead of focusing on government price controls, Congress should remove the obstacles limiting patient control and choice. The claim that prices are lower, and quality is higher, when consumers have more choices is typically uncontroversial. Yet, for some reason...

March 8, 2022 Issues, Price and Costs

Popular wisdom is often wrong. Consider, for example, how it views organic agriculture, which has grown to a $48 billion a year industry in the U.S. Organic products are sold at outlets ranging from local farmers' markets to large supermarket chains, and many people assume that there is something more natural, wholesome, or environmentally sustainable about them. None of that is true. What's remarkable about this agriculture sector is that the government's extensive promotion has been a hoax from the beginning, having nothing...

March 8, 2022 Issues, Price and Costs

Late last month, the Federal Trade Commission announced it would seek public comments on the ways pharmacy benefit managers distort the prices of prescription drugs. PBMs deserve the scrutiny, as they're to blame for much of the rise in prescription drug costs. Insurers hire PBMs to negotiate drug prices with manufacturers and determine which medicines end up on a plan's formulary. To guarantee their drug has a spot on the list, pharmaceutical firms routinely offer these gatekeepers deep discounts on medications. Savings on...

March 1, 2022 Briefs, Policy Proposals, Price and Costs, Studies

READ THE REPORT The problem of drug affordability is caused by the perverse incentives created by the third-party payer system that have disempowered patients in favor of insurers and other supply-chain intermediaries. The insurance flaws have created pricing systems that inequitably transfer a disproportionate share of drug costs on to patients. This arrangement inappropriately imposes a drug affordability problem on patients who require expensive medicines. The insurance flaws also incent benefit design policies that create additional affordability burdens and unnecessarily increase...

February 28, 2022 Issues, Price and Costs

Too often, regulations undermine the competitive process in the name of promoting competition. The ill-conceived Right to Repair legislation exemplify the problems and risks. Under the pretense of promoting competition, states as diverse as Texas and California, Arkansas and Hawaii have all considered bills that would violate medical device companies’ intellectual property rights. While many have been defeated, some legislators seem intent on advancing one businesses interest over another, which undermines competitive efficiency and, in the case of medical devices, creates risks to patient care. At issue are the rules...

February 10, 2022 Issues, Price and Costs

Last week, President Joe Biden announced the re-launch of his "Cancer Moonshot" initiative, a project he created in 2016 while serving as Vice President in the Obama administration. The ambitious effort aims to "end cancer as we know it today" by, among other things, halving the death rate from the disease by 2047. That goal is laudable. It will also be impossible to achieve if the president continues to make prescription drug price controls a top administration priority. The only way to spur the...