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Healthcare Companies with a Conscience: How Benefit Corporations Can Reduce Healthcare Costs
Source Fellow November 9, 2017
By: Katie Beyer, Student Fellow As healthcare costs continue to rise from almost every angle, quality healthcare and treatment often come with a lofty price tag. Survival of private healthcare providers is contingent upon optimizing profits, such that a company’s motivation is driven by shareholder value instead of commitment to social responsibility. Good health at a fair price is often not the primary corporate goal for healthcare companies, but what if it could be? A benefit corporation is a new legal tool currently available in 33 states and allows private companies …
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The End of CSRs: Trump Eliminates “Bailouts” While Others Seek a Solution
Source Fellow October 30, 2017
By: Briana Moller, Student Fellow Trump Administration Has Eliminated CSR Payments On October 11, 2017, in a memo to the Department of Treasury and the Department of Health and Human Services (HHS), Attorney General Jeff Sessions provided his legal opinion that Cost Sharing Reduction (CSR) payments were unlawful. CSR payments reimburse insurance companies for losses in deductibles, copays, and coinsurance payments owed by lower income individuals in health plans on the Affordable Care Act (ACA) exchanges. The following day, Eric Hagan, the acting Secretary of HHS, announced that CSR payments …
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Bailout or Bust? How CSR Payments Are in a Precarious State
Source Fellow September 29, 2017
By: Briana Moller, Student Fellow What’s Happened Earlier this year, President Trump began discussing the idea of eliminating cost sharing reduction (“CSR”) payments to insurance companies. (1) CSR payments are reimbursements the federal government provides to insurance companies that provide discounts to enrollees with incomes between 100 and 250% of the poverty line. (2) In a recent tweet, the President referred to CSR payments as “bailouts” to insurance companies and threatened to end these payments “very soon!” So what does this all mean? If President Trump eliminates CSR payments, insurance …
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Academic Articles & Reports Roundup: September 2017
Source Fellow September 27, 2017
By: Katie Beyer, Student Fellow Happy October! In this Roundup of articles from the past month, we cover four articles from September. The topics this month include 1) actual R&D costs for single cancer pharmaceuticals|2) policy solutions beyond antitrust to promote competition and regulate consolidation|3) reasons behind market exclusivity for prescription drugs|and 4) state policy recommendations curbing healthcare consolidation efforts. Actual R&D Costs for Single Cancer Pharmaceuticals A 2017 Tufts University Center for Study of Drug Development and Research estimated the total cost of research and development (R&D) spending is $2.7 …
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Drug Money Part 2: A Look at 2017 State Legislative Efforts to Reduce Prescription Drug Prices
Source Fellow August 3, 2017
By: Katie Beyer, Student Fellow INTRODUCTION It is no secret that drug prices have been rising at an alarming rate. In fact, spending on prescription drugs rose 12.4% in 2014 and 9% in 2015.[1] In 2015, the U.S. spent $457 billion on prescription drugs, which accounted for 16.7% of overall healthcare services.[2] In 2016, Americans filled 4.4 billion drug prescriptions, at a total cost of approximately $400 billion.[3] On average, Americans spend $1,370 out of pocket on prescription drugs per year.[4] With an average annual price increase of approximately 10% over …
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Academic Articles & Reports Roundup: July 2017
Source Fellow August 1, 2017
By: Katie Beyer, Student Fellow Happy August! In this Roundup of articles from the past month, we cover four articles from July. The topics this month include 1) causes of recent drug price increases and how to reduce them|2) recent trends in health spending by state from 1991-2014|3) analysis of SHOP programs in California and Colorado|and 4) justifying universal health insurance. Causes of Recent Drug Price Increases and How to Reduce them The article Getting to the Root of High Prescription Drug Prices summarizes the major causes of rising prescription drug …
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Seventh Circuit Refuses to Revive a $300 Million Antitrust Lawsuit Against St. Francis Medical Center
Source Fellow July 25, 2017
By: Katie Beyer, Student Fellow Saint Francis Medical Center is the largest medical provider in the Peoria area, providing 616 hospital beds and a wide variety of inpatient services. Methodist Medical Center is about half the size, providing only 330 hospital beds. Saint Francis has exclusive contracts with four insurance companies – Aetna, Blue Cross and Blue Shield of Illinois, Health Alliance, and Humana – that prohibit the insurers from forming contracts with Saint Francis’ competitors. In 2013 Methodist sued Saint Francis, alleging that these exclusive contracts violate the Sherman Act …
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Academic Articles & Reports Roundup: June 2017
Source Fellow July 1, 2017
By: Katie Beyer, Student Fellow Happy July! In this Roundup of articles from the past month, we cover five articles all published in June. The topics this month include 1) Maryland’s anti-price gouging law|2) the 2018 medical cost trend|3) lowering generic drug costs through effective price transparency|4) state efforts to establish cost sharing standards|and 5) the effects of insurance coverage expansions. Maryland’s Anti-Price Gouging Law The New England Journal of Medicine published an article titled, Targeting Unconscionable Prescription Drug Prices – Maryland’s Anti-Price Gouging Law by Jeremy Greene, and William …
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Issue Brief: Certificates of Need
Source Fellow June 19, 2015
By: Evan Sznol, Source Fellow Certificate of Need Definition A Certificate of Need (“CON”) regime generally prohibits new or existing healthcare providers and facilities from making large capital expenditures or expanding services and facilities unless a genuine public need exists in the relevant geographic market. Private parties must apply for a certificate of need from the state’s health department before proceeding with a development that meets the statutory trigger, which varies from state to state. CON programs are typically used to restrict the growth of high cost healthcare services, long …
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Issue Brief: Most Favored Nation Clauses
Source Fellow June 19, 2015
*Editor’s Note (September 2020): See updated research paper on anticompetitive contract clauses including most-favored-nations clauses for more detailed analysis: “Preventing Anticompetitive Contracting Practices in Healthcare Markets”. By: Evan Sznol, Source Fellow Introduction: What is a Most Favored Nations Clause? The contract provision known as the most favored nations (“MFN”) clause is a promise obtained by a buyer from a seller that the seller will not give a better price to another buyer. In the healthcare context, an MFN clause typically manifests as a provision within a health network plan contract …
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