Drug Prices

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 ...

The three largest PBMs—Caremark (CVS Health/Aetna AET 0.0%), Express Scripts ESRX 0.0% (Cigna CI +0.7%), and OptumRx (UnitedHealth Group UNH +0.2%)—control 80% of the market and are integrated into large health insurance conglomerates. PBMs negotiate drug prices with pharmaceutical companies on behalf of insurers and manage their drug formularies. Read ...

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 ...

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 ...

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, the Department of Health and Human Services announced the first 10 drugs subject to the law’s price controls, which include the blood thinners ...

PBMs work for (or increasingly are part of) insurance companies. They decide which drugs patients can access and negotiate rebates to drugs’ list prices. The term “rebates” sounds like these discounts should benefit patients, but PBMs and insurers pocket these savings while basing patients’ costs on the higher undiscounted prices. ...

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 . . . It’s laudable that lawmakers want to reduce out-of-pocket ...

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 ...