Reforming Drug Price Regulation
Using Tools That Work
Bibliographic Data
| ID | 13775935 |
|---|---|
| Authors | Deborah Williams (0000-0002-4320-077X, Health Policy Insights LLC, Greer, SC, USA, corresponding author), Steven C Zima (The Cigna Group, Nashville, TN, USA), Brian J Miller (0000-0003-3247-8845, Johns Hopkins University School of Medicine, Baltimore, MD, USA) |
| Year | 2025 |
| Volume | 62 |
| Pages | 469580251335844-469580251335844 |
| Publication date | 2025-05-14 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | INQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL) |
| Journal identifiers | ISSN: 0046-9580 • E-ISSN: 1945-7243 |
| Publisher | SAGE Publishing (PUBLISHER • US) |
| DOI | 10.1177/00469580251335844 |
| PMID | 40366345 |
| OpenAlex | W4410382810 |
| Language | EN |
| Citations received | 1 |
| References cited | 19 |
Drug pricing reform to increase affordability has historically relied on increases in regulation often with a focus on administrative pricing for public programs in order to try to lower drug costs. This paper examines the consequences of this strategy, pointing out that regulated prices fail to drive affordability, create unintended, hidden costs to the system, and drive demand for a body of ever-growing regulatory interventions to address shortfalls created by prior policies. Within this context, the paper examines examples of regulations affecting large percentages of government payments the Medicaid Drug Rebate, the Inflation Reduction Act Maximum Fair Price, and the Average Sales Price formula in Medicare B enumerating how each of these programs that direct funds to Medicare or Medicaid only create hidden systematic costs when considered from the total market perspective. Next, a new paradigm for drug pricing reform philosophy is suggested, with a focus on market-based interventions to reform existing government regulation aimed at improving competition and consider examples of effective private market policies including co-insurance/copayment reform, private formularies, specialty pharmacies, and value-based contracting. The paper concludes by arguing that shifting from a programmatic view of affordability to an understanding of the regulatory effect on costs in the drug market, including regulatory burden reduction, is the best way to drive affordability for payers and thus ultimately for employers and consumers
Business · Competition (biology · Context (archaeology · Cost sharing · Economic growth · Economics · Formulary · Government (linguistics · Health care · Market economy · Market failure · Medicaid · Microeconomics · Public economics · Regulatory reform · Unintended consequences · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Pharmaceutical Economics and Policy
| Unique citing works | 1 |
|---|---|
| Citations per year | 1 |
| Citation span | 2025 - 2025 (1) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 1 |