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The Global Burden of Medical Innovation
Calculations using publicly available aggregate data suggest that the United States market accounts for 64% to 78% of worldwide pharmaceutical profits.
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Reining in Pharmaceutical Costs
The administration and lawmakers should prioritize four actions that could engender more cooperation and improve health over the long term.
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Medicare Advantage: Better Information Tools, Better Beneficiary Choices, Better Competition
Since the 1970s, and codified in the Tax Equity and Fiscal Responsibility Act of 1982, Medicare beneficiaries have had the choice of receiving their Medicare benefits through private health plans instead of the traditional fee-for-service (FFS) Medicare program administered by the federal government. The policy thrust of private plan participation in Medicare is that competition […]
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Taking Stock of Insurer Financial Performance in the Individual Health Insurance Market Through 2017
The Affordable Care Act (ACA) implemented wide-ranging reforms to the individual health insurance market starting in 2014, most importantly by barring insurers from denying coverage or varying premiums based on health status, requiring all plans to cover certain services and provide a basic level of financial protection, providing subsidies to help low- and moderate-income people […]
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A Better Approach to Regulating Provider Network Adequacy
Health care reforms, including those put in place by the Affordable Care Act, are making insurers more competitive. However, in their effort to lower costs, health insurers more often are selling health plans that cover fewer hospitals, and many fewer physicians. This narrowing of provider networks is a sign that market reforms may be improving […]
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Effects of the More Austere Medicaid Per Capita Cap Included in the Senate’s Health Bill
Last month, we analyzed how states and the federal budget would have fared had a Medicaid per capita cap like the one envisioned in the House-passed American Health Care Act (AHCA) been implemented in the recent past. On June 22, the Senate released a “discussion draft” of their Affordable Care Act repeal bill: the Better […]
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Would Price Transparency for Generic Drugs Lower Costs for Payers and Patients?
In 2016, roughly 62,000 retail pharmacies filled over 4.4 billion drug prescriptions, costing almost $400 billion and accounting for more than 10 percent of overall U.S. health care spending. Almost 9 of 10 retail prescriptions—4 billion—were for low-cost generic drugs, accounting for about $100 billion in drug spending. The actual cost of generic drugs is […]
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Flow of Money Through the Pharmaceutical Distribution System
For every $100 spent at retail pharmacies, about $17 compensates for direct production costs, $41 accrues to the manufacturer, and $41 accrues to intermediaries in the distribution system.
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Effects of Medicaid per Capita Cap Included in the House-Passed American Health Care Act
The American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, would alter how the costs of state Medicaid programs are shared between the federal government and states. In “Effects of the Medicaid Per Capita Cap Included in the House-Passed American Health Care Act,” (PDF) Loren Adler, Matthew Fiedler, […]
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Making Health Care Markets Work: Competition Policy for Health Care
The U.S. health care system does not work as well as it could, or should. Prices are high and rising,[1] there are serious quality problems,[2] and many characterize the system as rigid and unresponsive, lacking dynamism and innovation.[3] A lack of competition is a major contributor to this dysfunction. In some cases, markets lack the […]
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