Advertise on podcast: Prescription for Better Access

Casey Cormier, Stratis Group Emily Gibb, Novartis Stratis Group | Nexus Health Novartis Breaking Down Barriers: An Interview with Peyton Howell An Interview with Kathryn Carey, President, Optum Rx Pharmacy Benefit Manager One Big Beautiful Bill Act: Medicaid Work Requirements 340B Drug Pricing Program Medicare Drug Price Negotiation Program (Maximum Fair Price) Most Favored Nation Drug Pricing KFF: Copay Adjustment Programs (Accumulators and Maximizers)

In this episode, we sit down with Kathryn Carey, President, Optum Rx Pharmacy Benefit Manager, to discuss one of the most significant shifts underway in the pharmacy benefit management industry. We explore their new transparent, fixed-fee model, what is driving it, and what it actually means for patients, providers, pharmacies, and manufacturers. We also examine Optum Rx’s digital tools and how they are reshaping the prescribing experience, and the broader effort to reduce friction in patient access. At its core, this is a conversation about whether these changes are early stages of a new model for how medicines are accessed and paid for in the United States. Optum Rx New PMPM Model PBMs Explained PreCheck Prior Authorization PreCheck MyScript Shop MyScript Price Edge Price Wise Savings IQ Critical Drug Affordability Program Questions or comments?Email us at [email protected] us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we interview Stephen Ubl, President and CEO of PhRMA, to discuss what is happening across the industry at a time of significant change. We talk about biopharma’s continued commitment to innovation, what member companies are doing to help patients access medicines more directly, and how new tools from the organization are supporting patient affordability. We also cover the impact of policies like the IRA and MFN, along with the growing focus on PBM reform and other structural challenges in the system. It is a wide-ranging conversation about where the industry is headed and what it will take to ensure the country continues to lead the world in bringing new treatments to patients in need. Steve Ubl, CEO of PhRMA PhRMA PhRMA Leadership Transition PhRMA 3 Announcements Medicine Assistance Tool (MAT) America’s Medicines Jim Collins, Building Companies to Last FTC Settlement with Express Scripts IQVIA Data: Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation Most Favored Nation Drug Pricing 340B Drug Pricing Program New York Times: How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits Hatch-Waxman Act Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we sit down with Alexander Hardy, President and CEO of BioMarin, to talk about his path to leading one of the world's premier rare disease companies. Alexander reflects on his experience across small molecules, biologics, oncology, and rare diseases, and how his work in access and patient services has shaped his thinking about leadership. We discuss the policy environment coming out of Washington — including the IRA and other pricing reforms — and how those factors influence long-term innovation and investment decisions. We also explore the real-world challenges facing rare disease patients, employer concerns about high-cost therapies, and what needs to change over the next five years to improve access and affordability. Alexander Hardy PathoGenesis Eli Lilly | GSK | Novartis Genentech — Access Solutions BioMarin — Rare Connections AUTHrd Act of 2026 (part of the EPIC Act, HR 1492/S832) — pending before Congress Health Technology Assessments in Rare Diseases Questions or comments? Email [email protected]. Find us on X, LinkedIn, YouTube, and Threads.

In this episode of Prescription for Better Access, we’re joined by William (Bill) Sarraille, a legal expert on drug access and reimbursement. He discusses two developments shaping the pharmacy benefit landscape: the FTC’s enforcement action involving Express Scripts and PBM reforms in the Consolidated Appropriations Act of 2026. Bill explains what these policy changes could mean for benefit design, drug coverage, employer-sponsored plans, and transparency in the PBM market. We also explore potential impacts on formularies, utilization management, contracting practices, and patient out-of-pocket costs, along with possible unintended consequences for employers, manufacturers, and patients seeking timely and affordable access to medicines. William (Bill) Sarraille, University of Maryland School of Law LinkedIn Pharmacy Benefit Managers (PBMs) FTC Settlement 2024 Administrative Complaint Cigna Healthcare Fair Market Value in Healthcare Consolidated Appropriations Act of 2026 Part D Plan PBMs No Longer Profit From Rebates But Plans Benefit – Pink Sheet TPA (Third Party Administrators) DOL Proposal Copay Accumulators and Maximizers Amicus Brief, HIV and Hepatitis Institute Questions or comments? Email us at [email protected]. Follow us on X, LinkedIn, YouTube, and Threads.

Employers sit at the center of the U.S. health system as the primary funders of coverage for more than 150 million Americans, yet they struggle with rising costs, fragmented vendors, and uneven outcomes. In this episode, we talk with Dan Mendelson, MPP, CEO of Morgan Health at JPMorgan Chase & Co. and Founder and former CEO of Avalere Health. We explore his journey from health policy to now leading Morgan Health’s efforts to improve the quality, affordability and equity of employer-sponsored healthcare. We’ll learn how Morgan Health evaluates the employer market, where they’re placing investment bets, and how they are testing new care models inside JPMorgan’s own benefit. We then turn to Washington: Dan shares his take on the policy currents that matter most for employers and innovators over the next few years. Dan Mendelson, CEO, Morgan Health LinkedIn Forbes Contributions Avalere Health Balanced Budget Act of 1997 Jamie Dimon, Chairman and CEO of JPMorgan Chase & Co. Continuation of Health Coverage (COBRA) Vera Whole Health, Central Ohio Primary Care Centivo Embold Health Cigna Healthcare Quantum Health Thyme Care 60 Minutes, “$2 million gene therapy could save her baby’s life. But insurance wouldn’t pay” PBM Alternatives Pharmacy Benefit Managers (PBMs) Individual Coverage Healthcare Reimbursement Accounts (ICHRA) Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

The FDA’s Accelerated Approval Program (AAP) aims to bring promising, potentially life-saving medicines to patients sooner by allowing approvals based on surrogate endpoints while requiring timely confirmatory evidence. In this episode, we speak with Bridget Doherty, MPH, MS (Johnson & Johnson Innovative Medicine), and Jeff Allen, PhD (Friends of Cancer Research). Bridget discusses her team’s review of the AAP’s real-world impact, showing that hundreds of thousands of meaningful life-years have been gained for patients. Jeff shares findings from work strengthening biomarkers as reliable surrogate endpoints—helping define when increased speed can still preserve scientific rigor. We also explore the core access challenge: how payer coverage and utilization management help or hinder patients the AAP is designed to serve. We close with practical policy steps to ensure that earlier regulatory access truly leads to better outcomes for people who need treatments most. Bridget Doherty, MPH, MS, Johnson & Johnson Jeff Allen, Friends of Cancer Research J&J Center for U.S. Healthcare Policy Research Friends of Cancer Research Accelerated Approvals in Oncology Tracker Drug Development Dashboards 30 Years of Accelerated Approval: Data-Driven Insights Analysis of FDA Biomarker Qualification Program Original JNCCN Study How Gleevec Transformed Leukemia Treatment Immunotherapy Surrogate Endpoints Confirmatory Trials Years Gained from the FDA Accelerated Approval Program (2024) Circulating Tumor DNA (ctDNA) ctMoniTR Project Questions or comments? Email us at [email protected]. Find us on social media: X, LinkedIn, YouTube, and Threads.

In this episode, we talk with Richard Xie, Senior Health Economist at RA Capital, and Gunnar Esiason, Senior Director of Patient Engagement at Raven (RA Capital Ventures), about value frameworks in pharma. We unpack how Generalized Cost-Effectiveness Analysis (GCEA) builds on traditional Cost-Effectiveness Analysis (CEA) and differs from ICER’s model. The conversation explores what these approaches mean for pricing, access, and patient voice—especially in rare and high-innovation settings. Through the Cidara CD388 flu drug case, we discuss how assumptions shape value and trade-offs from manufacturer and patient perspectives. The episode highlights how evidence, incentives, and outcomes align—or conflict—in today’s system, and what reforms could better connect value frameworks to affordability and equitable access. Richard Xie, Senior Health Economist, RA Capital Management Gunnar Esiason, MBA, MPH, Senior Director, Head of Patient Engagement and Patient-Centered Innovation, Raven (RA Capital Ventures) Patient-Centered Value Assessment Models Episode 26: Sarah Emond, ICER Peter Kolchinski, The Great American Drug Deal NICE (UK) CDA (Canada) Australia CHAP Trikafta ICER Report on Cystic Fibrosis No Patient Left Behind GCEA Calculator Boomer Esiason Foundation Aurora Biosciences Most-Favored-Nation Drug Pricing Order Questions or comments? Email [email protected]. Follow us on X, LinkedIn, YouTube, and Threads.

In this episode, former CMS official Jon Blum reflects on the evolution and impact of the IRA’s drug provisions—from foundational drivers and political trade-offs to how 2026 Part D redesign and the M3P cost-smoothing program are reshaping access. We explore why M3P adoption remains limited, how CMS is monitoring plan behavior around negotiated pricing, and what shrinking standalone Part D options may mean for patients, especially in rural areas. Jon also challenges the “blame game” in Washington—emphasizing the systemic incentives behind each actor—and shares his own prescription for equitably balancing drug affordability, innovation, and policy integrity, including thoughts on MFN and future reform paths.

At ACCESS US 2025, our live podcast The Future of Access features four experts exploring how to improve drug affordability and access while maintaining innovation. With rising drug costs, we ask: What bold models are emerging? We cover benefit design, PBMs, AI, evolving pharmacy models, and whether markets can act before regulation. Conference Overview Sarah Emond – ICER John O’Brien – National Pharmaceutical Council Annette Powers – Bristol Myers Squibb Ray Pressburger – Accenture Stuart Altman – Power, Politics and Universal Health Care PBMs 340B Program Copay Maximizers Net Price Lilly Direct Indolent Disease, PFS Concomitant Drug HIV & AZT Orphan Drugs Calquence vs Imbruvica Value-Based Contracts Outcome-Based Contracts Disruptive PBMs CostPlus Drugs Fair Access 2024 Drug Rebates Drug Carve-Outs Dynamic Pricing Accelerated Approvals ICER Assessment Questions? Email [email protected]. Follow us on X, LinkedIn, YouTube, and Threads.

Specialty drug benefit design isn't just one decision — it triggers a domino effect impacting employer and health plan costs, patient access, care delivery and patient cost-sharing. In this episode, we unpack PSG’s latest research on how employers and health plans are rethinking specialty strategies amid rising pressure: cost management as a top priority, movement toward rebate alternatives, shifting site of care models, and evolving approaches to affordability and utilization management. Our guests break down where the biggest shifts are happening, what’s still missing, and how smarter benefit design can create better outcomes across the healthcare system. PSG (Pharmaceutical Strategies Group) 2025 Trends in Specialty Drug Benefits Report Specialty Drugs Drug Utilization PBM (Pharmacy Benefit Manager) Copay Assistance (Maximizers & Accumulators) Drug Rebates Drug “Carve Outs” Value-Based Agreements Utilization Management Step Therapy Biosimilars Site-of-Care Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we interview Brian Reid, the founder of Reid Strategic and the creator and editor of our favorite industry newsletter, the Cost Curve. Brian shares his journey to create the Cost Curve and how he navigates the onslaught of information to identify the most important issues of the day. We also get his take on what he calls the highest “importance-to-attention” healthcare stories, highlighting critical topics that are undercovered related to their significance. We also get the opportunity to understand his perspectives on the threats to innovation, the risks to patient affordability programs, and what all of us should be doing to be better healthcare consumers. Brian Reid- Reid Strategic Cost Curve Newsletter Martin Shkreli & Daraprim BioPharma Dive: Biotech and Pharma Industry News GLP-1s Net Price– “a drug’s net price equals the actual revenues that a manufacturer earns from a drug after rebates, discounts, and other reductions” Source: Drug Channels  Armamentarium Pharmacy Benefit Managers (PBMs) Mark Cuban Pharmacy Psuedo-Generic Medication CVS Cordavis Quallent Nuvalia Biosimilars Lilly Direct Novo 340B Drug Pricing Program Copay maximizers AFPs Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we explore the complex and often debated concept of value in prescription drugs. They discuss how different stakeholders—payers, manufacturers, providers, regulators, and patients—define value, and how methodologies like health technology assessments (HTA) and cost-effectiveness analyses shape drug pricing and access. With insights from leading experts, the conversation examines the controversies surrounding value-based pricing, including the role of real-world evidence, quality-adjusted life years (QALYs), and innovation incentives. Can we strike a balance between affordability, innovation, and patient access? And what does the future hold for value-based drug pricing in the U.S.? Tune in for a deep dive into one of the most critical issues in healthcare today. Daniel Ollendorf, Chief Scientific Officer and Director of HTA Methods and Engagement Lou Garrison, Professor Emeritus at University of Washington CHOICE Institute for Clinical and Economic Review (ICER) FDA GLP-1 Drugs Medicare Biosimilars Generics Versus Biosimilars PBMs (Pharmacy Benefit Managers) 340B Drug Pricing Program Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we interview Sarah Emond, MPP, President and CEO of the Institute for Clinical and Economic Review (ICER). Sarah joined ICER over 15 years ago as Chief Operating Officer and was appointed to lead the organization following the retirement of Dr. Steven Pearson. Sarah outlines her vision for ICER and the priorities for strengthening the framework and collaboration to achieve their mission of evaluating the comparative effectiveness of new medicines. Sarah also discusses ICER’s efforts to expand patient engagement and the evaluation of payers to ensure fair access to medicine. Sarah Emond, MPP, President and CEO, Institute for Clinical Economic Review (ICER) Dr. Steven Pearson, Founder, President, Institute for Clinical and Economic Review (ICER) Barriers to Fair Access Report  Gross-to-Net Bubble Pharmacy Benefit Managers (PBMs) Humira biosimilars Institute for Clinical and Economic Review (ICER) 340B Drug Pricing Program Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we sit down with Stacie Dusetzina, Ph.D., a leading health economist from Vanderbilt University Medical Center to discuss the critical healthcare and policy trends shaping 2025. From shifts in federal leadership to the evolving impact of the Inflation Reduction Act, our guest provides expert insights on what to expect in drug pricing, health insurance, and patient access in the coming year. We explore how the public and private sectors are addressing affordability challenges and highlight innovative approaches to improve access to essential medications. With a focus on the future, this conversation offers a thoughtful outlook on the policies and market dynamics set to redefine healthcare in 2025. Stacie Dusetzina, Ph.D., Vanderbilt University Vanderbilt University Medical Center A primer on copay accumulators, copay maximizers, and alternative funding programs CMS  FDA IRA Medicare Part D Pharmacy Benefit Managers (PBMs) Medicaid CMMI’s Medicaid group negotiation  COVID-19 Statins PCSK9 inhibitors Imatinib 340B Drug Pricing Program Questions or comments? Email us at [email protected]. Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.