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Yahoo
09-05-2025
- Health
- Yahoo
Pioneer Institute Launches Tracker Showing Drug Price Controls Are Raising Out-of-Pocket Costs for Medicare Patients
New data tool shows out-of-pocket costs have increased for most drugs targeted by Inflation Reduction Act price controls BOSTON, May 09, 2025--(BUSINESS WIRE)--A new data tool from Pioneer Institute reveals that federal drug price controls—intended to reduce out-of-pocket costs for seniors—are instead making many prescription drugs more expensive for Medicare beneficiaries. The IRA Medicare Drug Access Tracker, developed by Dr. William Smith and Dr. Robert Popovian, monitors the impact of the Inflation Reduction Act's (IRA) drug pricing provisions. Its first analysis shows that among nine commonly prescribed medications which were subject to price setting by the IRA —used to treat conditions like heart failure, diabetes, and blood clotting—seven saw an increase in patient out-of-pocket costs. (The insulin product was not studied since its price was fixed in statute under a separate IRA provision.) "The price controls show that Congress fundamentally doesn't understand the rebate system that underpins the pharmaceutical market," said Dr. William Smith, who built the Tracker with Dr. Robert Popovian. "All the politicians who argued that the IRA law would make drugs more affordable should look at this new data." Under the current system, drug manufacturers pay substantial rebates to pharmacy benefit managers (PBMs) such as Caremark and Optum. These rebates help offset costs but are invisible to patients. When CMS seeks to control prices by lowering a drug's official "list price," as it does with the anti-coagulant Eliquis—bringing the price down from $521 to $231—rebates disappear, likely eliminating hundreds of millions in rebate payments from manufacturers to PBMs. PBMs appear to be compensating for that loss by raising co-pays, co-insurance, and transferring other charges directly to patients. The IRA Medicare Drug Access Tracker focuses on Medicare patients served by the four largest PBMs, which account for 87 percent of the market. The tool is designed to measure whether federal price controls actually improve affordability for seniors by tracking out-of-pocket costs over time. It also follows administrative burdens that PBMs may have imposed on these drugs, which may strain already short-staffed providers, such as requiring them to fill out additional paperwork to secure a prescription (prior authorization) or placing quantity limits on the medications. Such administrative burdens are often used in the industry to discourage demand (demand management). Among the Tracker's key findings: Average out-of-pocket costs for the nine drugs rose 32 percent, from $74.51 to $98.42 Seven of the nine drugs saw individual cost increases ranging from $10.56 to $316.81 One of the two medicines seeing no increase in out-of-pocket costs faced competition from biosimilars that only became available in 2025 "Higher out-of-pocket costs are unlikely to be the only unintended consequence of drug price controls," Dr. Popovian said. "The IRA also creates less incentive for pharmaceutical innovation and increases the possibility that some popular drugs may be excluded from health insurance formularies." This release marks the Tracker's first report. Pioneer Institute will publish additional data later this year, as more drugs fall under the Inflation Reduction Act's price-setting provisions. The public can find the tool at Dr. William S. Smith is Senior Fellow & Director of Pioneer Life Sciences Initiative. Dr. Smith has 25 years of experience in government and in corporate roles. His career includes senior staff positions for the Republican House leadership on Capitol Hill, the White House Office of National Drug Control Policy, and the Massachusetts Governor's office where he served under Governors Weld and Cellucci. He spent ten years at Pfizer Inc as Vice President of Public Affairs and Policy where he was responsible for Pfizer's corporate strategies for the U.S. policy environment. He later served as a consultant to major pharmaceutical, biotechnology and medical device companies. Dr. Smith earned his PhD in political science with distinction at The Catholic University of America. Dr. Robert Popovian is the Founder of the strategic consulting firm Conquest Advisors. He also serves as Chief Science Policy Officer at the Global Healthy Living Foundation, Senior Healthy Policy Fellow at the Progressive Policy Institute, and Visiting Health Policy Fellow at the Pioneer Institute. He previously served as Vice President, U.S. Government Relations at Pfizer. One of the country's foremost experts on every significant facet of biopharmaceuticals and the healthcare industry, he is a recognized authority on health economics, policy, government relations, medical affairs, and strategic planning. To learn more about Dr. Popovian please click here. About Pioneer Institute Pioneer empowers Americans with choices and opportunities to live freely and thrive. Working with state policymakers, we use expert research, educational initiatives, legal action and coalition-building to advance human potential in four critical areas: K-12 Education, Health, Economic Opportunity, and American Civic Values. Please see below the first group of drugs subject that Pioneer is studying. Eliquis Enbrel Entresto Farxiga Imbruvica Januvia Jardiance Stelara Xarelto View source version on Contacts Media Contact: Amie O'Hearn aohearn@ Sign in to access your portfolio
Business Wire
07-05-2025
- Business
- Business Wire
New Study Warns: Rent Control Offers Short-Term Relief, But Steep Long-Term Costs
BOSTON--(BUSINESS WIRE)--A new Pioneer Institute study finds that while rent control can lower rental housing costs and help vulnerable tenants remain in their homes, it also carries steep long-term consequences—including reduced housing quality, lower property values, fewer new housing units, and higher rents for non-controlled apartments. Today, over three-quarters of Greater Boston households earning less than $75,000 per year spend more than 30 percent of their income on housing. Only Washington, D.C. and Chicago have lower rental vacancy rates among U.S. metropolitan areas. 'Public debates over rent control policies reflect a trade-off between the short-term need to provide housing stability to vulnerable families and the long-term need to build enough housing to meet overall demand,' said Andrew Mikula, co-author of 'Stability, Affordability, and Urgency: The Potential Risks and Benefits of 21 st Century Rent Control in Massachusetts' with Aidan Enright. Rent control—typically defined as limits on residential rents or annual rent increases—was eliminated in Massachusetts through a 1994 initiative petition. But with the growing housing affordability crisis, particularly in Greater Boston, interest in rent control has returned. Today, over three-quarters of Greater Boston households earning less than $75,000 per year spend more than 30 percent of their income on housing. Only Washington, D.C. and Chicago have lower rental vacancy rates among U.S. metropolitan areas. In 2021, Boston Mayor Michelle Wu proposed a 'rent stabilization' policy that passed the City Council but has since stalled in the Massachusetts Legislature. Wu's plan would cap annual rent increases at the lower of 10 percent or 6 percent plus CPI, with exemptions for new construction under 15 years old and owner-occupied buildings of six or fewer units. Under this policy, landlords may reset market rates between tenants. Wu's proposal is similar to several 'next generation' rent stabilization programs in place elsewhere in the country. Oregon, for example, caps rent increases at 7 percent plus CPI (10 percent in 2025) and similarly exempts new construction. Most academic research shows that rent stabilization policies reduce housing quality and property values and often result in higher rents for units that remain unregulated. A plurality of studies also find that rent stabilization policies reduce overall housing supply. In a 2022 national survey of multi-family housing developers, 87.5 percent said they would avoid building in jurisdictions with rent control policies. Mikula and Enright conclude that demand-side programs—such as rental vouchers and direct rent subsidies—are more effective in helping low-income renters. These programs provide greater housing stability and increase opportunities for upward mobility without discouraging landlords from maintaining or offering rental units. Massachusetts is one of just four states that operate its own rental voucher program in addition to the federal Housing Choice Voucher Program. 'Long-term, the solution to our housing problem lies in producing enough housing to meet demand,' Enright said. 'That means streamlined permitting procedures and more flexible zoning laws and building codes.' Andrew Mikula is a Senior Fellow in Housing at Pioneer Institute. Beyond housing, Andrew's research areas of interest include urban planning, economic development, and regulatory reform. He holds a Master's Degree in Urban Planning from the Harvard Graduate School of Design. Aidan Enright is Pioneer's Economic Research Associate. He previously served as a congressional intern with Senator Jack Reed and was a tutor in a Providence city school. Mr. Enright received a B.S. in Political Science and Economics from the College of Wooster. Pioneer empowers Americans with choices and opportunities to live freely and thrive. Working with state policymakers, we use expert research, educational initiatives, legal action and coalition-building to advance human potential in four critical areas: K-12 Education, Health, Economic Opportunity, and American Civic Values.
Yahoo
14-04-2025
- Health
- Yahoo
What is 340B and how does it impact hospitals' bottom line?
() A somewhat obscure federal program designed to reduce drug prices for health providers is getting scrutiny from lawmakers this year, with many questioning whether those savings are being used effectively for underserved patients. As designed, the 340B program requires participating manufacturers to sell discounted drugs to providers seeing low-income and underserved populations. Between 2005 and 2023, the program's total drug purchases grew from $2.4 billion to $66.3 billion — with the explosive growth exposing a rift between the pharmaceutical companies supplying the discounts and the hospitals receiving them. In response, state legislators are considering a bill to establish reporting requirements on qualified 340B entities, with a special focus on the dozens of hospitals accessing low-priced medications. 'Transparency has been kind of a key word for everything we've done this session — for the last couple of sessions — and this is focusing a light,' said Sen. Ed Charbonneau, who authored the proposal. 'What's going on is legal, but it is far askance from the purpose of what the whole thing was — to provide low-cost medications to the indigent people needing help.' Senators opted not to concur with House amendments, sending Senate Bill 118 to a conference committee to finalize negotiations. But the latest version would require certain health providers under the program report: aggregate drug acquisition costs and payments, pharmacy dispensing payments, claims, how 340B savings were used, patient makeup and more. But for some of the small hospitals using the program, every dollar saved is vital to continue their services. 'We don't have the economies of scale that larger tertiary centers have. We have to make do with very little oftentimes,' said Brenda Reeta, the CEO of the Greene County General Hospital. 'The cuts are getting deep enough now that it's going to be bordering on … not just cutting service lines but, 'Can we even stay open?'' In committee testimony, much of the program's criticism can be summarized by William S. Smith, a senior fellow overseeing life science initiatives at the Pioneer Institute think tank in Boston. Smith presented roughly 15 slides before both Senate and House committees in January and March describing how hospitals, clinics and pharmacies can acquire medications at a 'deep, deep' discount and then bill private insurers the full price — keeping the difference in a practice known as arbitrage. 'Arbitrage drives this and that creates all sorts of bad incentives for the program because hospitals have every reason to bring in fully insured patients and not to treat uninsured patients,' Smith told senators in January. As evidence of this practice, Smith pointed to the opening of contract pharmacies affiliated with 340B entities in wealthy communities with high rates of private insurance. 'Jeff Bezos could walk into a 340B pharmacy and get a 340B drug,' Smith said. 'It should be targeted for low-income patients or uninsured patients, in my view.' An Indiana one-pager from Pioneer concludes that more than half of these contract pharmacies are in affluent neighborhoods, dispensing drugs on behalf of 340B entities. Some of the state's largest nonprofit hospitals use contract pharmacies based in California and Hawaii, a point of contention for Pioneer. Additionally, Smith criticized a decline in reported charity care. Lawmakers have amended the bill to exclude reporting requirements for 340 entities like Health Resources and Services Administration clinics. Programs under that umbrella include programs like the Damien Center's services for Hoosiers with HIV or the Indiana Hemophilia and Thrombosis Center. Such clinics testified that they are already subject to stricter reporting requirements and auditing than hospitals. 'I think clinics are different than hospitals. The clinics, generally, run things better. They're audited on their charity care,' Smith said. '… and some hospitals are under-reimbursed by Medicaid and they really depend on 340B. That's why I like (Senate Bill 118) because it doesn't undercut the program. It just says, 'What's going on? How much money are you making?'' Before House lawmakers in March, Smith doubled down, targeting larger hospital systems for additional scrutiny. 'They're cutting back on their charity care and … collecting tens of millions of dollars in revenue from 340B. I'd like to find out which hospitals are doing the right thing and which ones are not and a little transparency would help,' Smith said. Such concerns have reached Gov. Mike Braun as well, who issued an executive order in January ordering Health and Family Services Secretary Gloria Sachdev to examine the program and determine what oversight the state could pursue. Such a review is set to be finalized by the end of October. Pushing back, hospitals said the savings from 340B weren't ever meant to go directly to patients — something Smith also said. But rather, hospital administrator said, it offsets other programming. 'If we focused on charity care, it suggests that our savings should be solely used to support charity care versus stretching scarce resources,' said Dawn Moore, a vice president and chief pharmacy officer with Community Health Network testifying on behalf of the Indiana Hospital Association. Moore additionally noted that charity care 'only' considered services that were billed and then written off, leaving out free clinics, patient navigation services and more. 340B savings were generated when billing a private insurer, since the program can't be applied to medications under Medicaid — hence why contract pharmacies may not be located in low-income areas. An obscure drug discount program stifles use of federal lifeline by rural hospitals 'We set up or provide services all throughout. However, because we generate a savings from locations where we have commercially insured patients, we take those savings and reinvest them where they're needed,' Moore said. Reetz, with the Greene County hospital, estimated that her hospital got roughly $500,000 in benefits from 340B but spent nearly half of that on self-auditing and administration. Though comparatively small, having that cushion allowed her system to keep its obstetrics and gynecology service lines open as well as cardiopulmonary rehabilitation. 'We are one of the few rural communities that still has full OB services … It's very costly to keep an OB department open and we have chosen to do that because, for us, it would be over an hour away for most of our community members to travel to deliver a baby,' said Reetz. 'Within the last couple of weeks, we had a person come in that did not plan to deliver at our hospital but the baby was coming right now. 'It was a complicated pregnancy and had she not been able to have an emergency (caesarean) section right then and there, the baby would have most definitely not made it. And most likely the mom too,' Reetz continued. Additional reporting requirements could eat into that money recouped from 340B, Reetz worried, on top of the other reporting and transparency requirements imposed on hospitals. Unlike other programs, no tax dollars are spent under the 340B program. 'I don't necessarily get why they're trying to push for more transparency, because I believe it's already as transparent as we can possibly be with it. It is just going to further dip into how much we actually are able to benefit from the program by making the administration of it even more costly,' Reetz said. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
29-03-2025
- Business
- Yahoo
Why is the U.S. Housing Market Short By Nearly 4 Million Homes?
The supply of U.S. homes undershot demand by 3.8 million homes in 2024, according to a report. The report showed that builders would take 7.5 years to catch up with demand as inventory struggles pressure home affordability. Zoning rules were cited as a major issue in undercutting new home construction, especially single-family housing rules that limited the construction of more affordable housing. Economists debated how to address making improvements to zoning, as some changes led to higher long-term builders made a small dent in the number of houses needed to meet demand, but the U.S. housing market supply remains short by millions of homes. The U.S. housing market needs as many as 3.8 million more homes to meet the demands of homebuyers in 2024, according to data from extending the trend of limited home inventory that has put pressure on home affordability. It's the first year since 2016 that home construction outpaced new household formation, showing that builders are beginning to catch up to the ongoing housing shortage. However, economists Hannah Jones and Danielle Hale estimated it would take more than seven years for builders to construct enough homes to close the gap between demand at 2024's rate. 'We're still years away from a normal, healthy housing situation,' said Robert Frick, corporate economist at Navy Federal Credit Union There are several factors that have led to the housing supply falling short. Following the 2008 financial crisis that was spurred by a plunge in the housing market, homebuyer demand dropped, leaving builders to construct fewer houses, Frick said. Now that housing demand is rising, builders face new obstacles, including local zoning rules that can discourage the development of more affordable housing options. One frequent policy target is single-family zoning, which covers about 75% of U.S. residential land but can often prohibit the construction of multifamily units or other more affordable options. Some economists oppose exclusive single-family zoning, arguing that builders will construct more affordable housing if permitted. Some proposals include allowing the construction of accessory dwelling units on properties in single-family zoning areas or including duplexes or smaller apartment buildings in zoning rules. However, other researchers say making these zoning changes may not lead to more affordable outcomes. The Boston-based Pioneer Institute found that while some zoning changes in Massachusetts led to more affordable housing options, the effects could affect long-term, broad-based affordability. 'Except in Boston and Cambridge, most of these policies have produced a paltry amount of affordable housing,' said Andrew Mikula, a Pioneer Institute researcher. 'It's extremely difficult to find a scalable way to align the math behind real estate development with programmatic mandates for affordable housing.' Read the original article on Investopedia Sign in to access your portfolio
Associated Press
12-03-2025
- Politics
- Associated Press
The Lost Decade Calls for Replacing 'Social Justice Education' with Education Rich in Liberal Arts
Book finds that marginalized students suffer most from turn away from academics BOSTON, MA / ACCESS Newswire / March 12, 2025 / Five years into the rise of so-called social justice education, it is leaving the students it aims to help less educated, more vulnerable and more marginalized, according to a new book published by Pioneer Institute. 'Inundating marginalized students with messages about their oppression and supposed incapacity has been deeply harmful,' said Steven F. Wilson, author of The Lost Decade: Returning to the Fight for Better Schools in America. 'We should instead work to provide all public-school students with the rich liberal arts education that has long been afforded to the privileged.' The power of a liberal arts education, high expectations, safe and orderly classrooms, and relentless attention to great teaching is proven. A Stanford University study found that in New York City, 'no excuses' schools operated by charter management organizations that embodied this approach generated an additional 110 days of learning in reading and 124 days in math in a single year. It was also clear that the schools can narrow or eliminate achievement gaps at scale. Nationwide, these 'gap-closing' schools were adding around 50,000 students-the size of the Boston public school district-each year. In Massachusetts, the framers of the 1993 Education Reform Act-William Weld, Thomas Birmingham, and Mark Roosevelt-all shared a profound formative experience: an outstanding liberal arts education. Extending the opportunity they were afforded to all students was at the heart of the reform they crafted, and the Commonwealth's public schools soon became the finest in the country and competitive with the best in the world. Urban charter public schools in Massachusetts also recorded spectacular academic gains. According to a Brookings Institution report, 'the test score gains produced by Boston charters are some of the largest that have ever been documented for an at-scale educational intervention.' The racial reckoning The racial reckoning that followed the 2020 murder of George Floyd by a Minneapolis police officer could have spurred on the transformation of urban schooling that charter schools sparked. It could have assailed big-city systems' chronically low expectations of students. The catastrophic learnings losses from the pandemic could have lit a fire under districts to accelerate instruction and urgently make up lost academic ground. They did nothing of the sort. Instead, they fueled what Wilson terms the Political and Therapeutic Evasions-the substitution of social justice training for academics, the provision of therapy in place of instruction. Academic achievement-rarely venerated in American schools to begin with-was demoted, if not scorned. A new 'social justice' approach to education newly pervades America's urban schools. It holds that objectivity and urgency are symptoms of toxic white supremacy culture, that truth is a phantasm and liberal education is elitist and colonialist. Before teaching academics, school justice educators claim, schools must address the trauma teachers and students experience from living in a white supremacist society. 'The result of seeking to 'heal' and politically 'awaken' staff and students before teaching academic content creates yet another excuse for failure,' said Director of Pioneer Education Jamie Gass. Even many gap-busting urban schools adopted this approach. In one of them, Boston Collegiate Charter School, the percentage of grade 8 students scoring proficient or advanced in English language arts (ELA) tumbled from 22 points higher than their Boston Public Schools counterparts in 2019 to nine points below that of the Boston Public Schools in 2024. Two New York City charter networks, Success Academies and Classical Charter Schools, resisted social justice education. In the spring of 2024, 95 percent or more of students in both networks were proficient in math and 82 percent in ELA. After Success, the four next largest New York City charter networks embraced, to varying degrees, social justice education. By 2024, students in their schools saw their proficiency advantage over the New York City Public Schools shrink by two thirds. By 2024, students in networks that pivoted the hardest to Antiracism were scarcely more likely to be found proficient in ELA than district school students. 'Literacy and numeracy are the keys to upward mobility,' said Pioneer Executive Director Jim Stergios. 'The movement to bring about justice by watering down curricula has clearly failed.' At the mid-point of the decade, it is time to choose another path. 'We can equip all children with a rigorous and engaging liberal arts education that arouses curiosity, venerates knowledge, cultivates compassion, and upholds reason, Wilson said. We can return to creating a new generation of schools that lift achievement for all students and build a more equitable and just society.' ### About Steven F. Wilson Steven F. Wilson is a senior fellow at Pioneer Institute. An education entrepreneur, policymaker, and writer, Wilson founded and built Ascend Learning, a network of fifteen tuition-free, liberal arts charter schools in Central Brooklyn. The Center for Research on Educational Outcomes (CREDO) at Stanford University identified Ascend as a 'gap-busting' network for its success in closing-and reversing-achievement gaps of race and income. His most recent venture, the National Summer School Initiative, provides accelerated instruction in the wake of the pandemic to 150,000 urban students. His first book, Reinventing the Schools: A Radical Plan for Boston, drove the development and passage of the Massachusetts charter school law. Learning on the Job: When Business Takes on Public Schools won the Virginia and Warren Stone prize for an outstanding book on education and society. His new book, The Lost Decade: Returning to the Fight for Better Schools in America, will be published by Pioneer in March. About Pioneer Institute Pioneer empowers Americans with choices and opportunities to live freely and thrive. Working with state policymakers, we use expert research, educational initiatives, legal action and coalition-building to advance human potential in four critical areas: K-12 Education, Health, Economic Opportunity, and American Civic Values. (202) 988-3222
