Issue Brief
Drug Money (Part 1): What Limits Competition in the Pharmaceutical Market?
Anna Zaret, Managing Editor and Grace Lee, Research Fellow January 19, 2017
Introduction In the last year, the public’s outrage about high healthcare costs became more narrowly targeted on pharmaceutical companies. Two major stories about price increases on pharmaceutical products helped fuel the public’s frustration. First in February, Turing Pharmaceuticals CEO Martin Shkreli testified before congress about his company’s decision to raise the price of Daraprim, the drug used to treat parasitic diseases, particularly occurring in HIV and AIDs patients, from $13.50 to $750 per dose.[1] And then in November, Mylan CEO Heather Bresch testified before Congress about a nearly 500 percent price increase of the epinephrine delivery device …
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Pharmaceutical Pricing: Lack of Competition in the Pharmaceutical Market
Anna Zaret, Managing Editor and Grace Lee December 15, 2016
Pharmaceutical Pricing: Lack of Competition in the Pharmaceutical Market Introduction Rising healthcare expenditures have been a source of concern for many years, but more recently, the concern has begun to focus specifically on prices and spending on prescription drugs, and for good reason. In 2015, expenditures on prescription drugs rose faster than overall healthcare spending.[1] According to a report issued by the Department of Health and Human Services (DHS), while overall healthcare spending has risen at a consistent rate, pharmaceutical spending sharply rose from 2010 to 2014. The high prices …
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Looking Ahead: The Future of the Affordable Care Act Under a Trump Presidency
Anna Zaret, Managing Editor November 17, 2016
Now that Donald Trump has won the White House, and Republicans have gained control in both the House and Senate, we will see modifications to the Affordable Care Act (“ACA”) in the future, although it is not entirely clear what those modifications will entail. Some consensus exists, however, on at least three issues related to the future of the ACA. First, change on-the-ground is not going to be felt immediately, even if bills modifying the ACA are signed in to law quickly. This means, importantly, that nothing is going to …
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Healthcare Costs & Competition in the 2016 Election
Anna Zaret, Managing Editor October 14, 2016
In the second presidential debate, an undecided voter asked Hillary Clinton and Donald Trump how they would each address high healthcare costs and improve insurance coverage. It was an opportunity for the campaigns to highlight their visions on health policy, which has been outside the spotlight for most of the campaign. Clinton’s answer focused on fixing the rising costs of ACA exchange plans, while Trump argued that the ACA should be repealed, and replaced with rules that allow insurance to be purchased across state lines. There’s a lot to discuss …
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Issue Brief: Gobeille v. Liberty Mutual (SCOTUS)
Elizabeth Nicholson, Research Fellow December 10, 2015
OVERVIEW The reach of All Payers Claims Database (“APCD”) legislation is currently being tested in Gobeille v. Liberty Mutual Insurance Company, Docket No. 14-181, which is presently before the U.S. Supreme Court. The case stems from Liberty Mutual’s refusal to comply with Vermont’s reporting requirements under that state’s APCD statute, which the insurer argues is preempted by The Employee Retirement Income Security Act of 1974 (“ERISA”)—a notoriously broad statute that preempts any state law that “relates to” a self-insured plan. FACTS Pursuant to Vt. Stat. Ann. Tit. 18, Section 9410, …
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Updated Issue Brief: All Payer Claims Databases
Elizabeth Nicholson, Research Fellow December 8, 2015
Introduction: What is an All-Payer Claims Database? An All-Payer Claims Database (“APCD”) is an electronic system that aggregates claims and administrative data from public and private payers. APCDs allow states to monitor utilization and healthcare charges across all payers, and, as such, are key tools for policymakers to identify and respond to systematic trends among (nearly) all delivery settings. According to the APCD Council (a collaboration between the University of New Hampshire and the National Association of Health Data Organizations), 18 states have existing APCDs.[1] Further research by the Source …
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Issue Brief: 2015 Price Transparency Initiative State Survey: Price Disclosures
Elizabeth Nicholson, Research Fellow October 21, 2015
OVERVIEW State legislatures have shown a lot of interest in health care price transparency initiatives this year. At least 27 states have proposed price transparency legislation in 2015. This legislation takes the form of disclosure requirements aimed primarily at health care providers and health insurance carriers.[1] These initiatives require individual health care providers, hospitals, and insurance carriers to disclose health care prices, charges, and reimbursement rates in a variety of ways. HEALTH CARE PROVIDERS The majority of current price transparency initiatives are aimed at health care providers. These initiatives require …
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Case Study in State Price Transparency Bills: Oregon
Elizabeth Nicholson, Research Fellow September 28, 2015
Oregon was one of 44 states to receive a failing grade on the Catalyst for Payment Reform and HCI3’s Report Card on State Price Transparency Laws, in March 2014. This session, state senators proposed two bills aimed at price transparency: SB900, which passed and SB891, which died upon committee adjournment. A few states have mounted similar efforts to either SB900 or SB891. Oregon provides us with a unique case study since it is the only state legislature to set forth both types of initiatives in the same legislative term. While SB900 is a …
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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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