Health Care Policy (Federal)

The reality is that non-price factors, including several players, are causing net prices to decline and retail prices to increase. Those players include employers, health plans, and pharmacy benefit managers (PBMs), all of whom have continuously circumvented the system through loopholes and complicated systems of reimbursement that tend to hurt patients

A new report by Cicero Institute, Pioneer Institute, and Reason Foundation reveals worrying stagnation in state-level telehealth expansion efforts in 2023, with only a few exceptions. Progress made during the pandemic is being lost even as provider shortages worsen, raising concerns about patients’ access to care.

A new Pioneer Institute study illustrates how the current system of drug pricing and discounts leads to patients with challenging diseases being charged huge out-of-pocket sums to keep other premiums low, effectively imposing financial penalties on the sick to protect the healthy and wealthy.

A proposal on Beacon Hill to expand insurance subsidies up to 500 percent of the federal poverty level, could push the small business insurance market into a death spiral, without reducing the number of uninsured and hurting those with preexisting conditions.

A Pioneer Institute study shows that middlemen—commercial pharmacies and pharmacy benefit managers—add substantial costs over wholesale prices. Allowing prescribers to dispense routine drugs would save consumers money without compromising safety.

A 2019 federal law requires hospitals to make prices for 300 shoppable services available online in a “consumer-friendly format,” but a Pioneer Institute survey of 19 hospitals finds that information on discounted cash prices—the price most likely to be charged to consumers paying out of pocket—was unavailable at seven of those hospitals.

Pioneer Institute Senior Fellows William Smith and Robert Popovian submitted public comments about PBM business practices to the Federal Trade Commission (FTC). Pioneer recommended that PBM discounts be passed along to patients when they are meeting their deductible or coinsurance requirements.

This report reviews the federal 340B drug discount program, showing that, over the past decade, the revenue for hospitals generated by the program, initially intended to serve low-income, uninsured populations, has exploded even while a number of important Massachusetts hospitals have reduced the level of charity care they provide. The study notes that nationwide, 340B drug sales rose from $9 billion in 2014 to $38 billion in 2020.

The toolkit aims to help policymakers take the next step toward a more quality-oriented, affordable, and innovative health system by ensuring that their state laws on telehealth remove deleterious barriers that have historically discriminated against those in certain geographies, such as those living in rural communities or in underserved urban areas. This report explains policy best practices for ensuring that providers and patients can fully realize the benefits of using telehealth services when appropriate and provides a simple-to-read stoplight rating for each state on how closely their policies align with those best practices.

The world was blindsided by COVID-19, but a new study finds that even as we continue to wrestle with the pandemic, another threat looms that scientists have long known about but the nation has thus far failed to address: the growth of...