Podcasts about drug pricing

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

In Episode 136 of DC EKG, Joe Grogan hosts Tom Barker, a top drug-pricing attorney at Foley Hoag and former acting general counsel of Health and Human Services (HHS) under the Bush administration. Tom helped implement Medicare Part D and now advises drugmakers and policymakers on complex pricing issues. The episode traces 20 years of policy: what went right with Part D, what the Inflation Reduction Act (IRA) did, and what effective policy should look like.Tom explains that Part D's success rested on three pillars: private plans only, limited government control over benefit design, and a non-interference clause barring the government from intervening in negotiations among plans, pharmacies, and manufacturers. Competition worked and premiums stayed low, until the government asserted more control and weakened those pillars. The IRA, he argues, was a 16-year Democratic effort to repeal non-interference, creating price controls disguised as negotiations.The Trump administration has taken a different tack, focusing not on the IRA but on MFN and Globe Guard models pegged to other developed countries. Tom also breaks down the 340B program, now the country's second-largest expenditure program, and the fight between manufacturers and covered entities over contract pharmacies.His prescription is simple: let competition work. Speed FDA approval of generics and biosimilars, and trust the marketplace over price controls. He points to hepatitis C, where prices fell sharply once competition entered.In This ConversationThe three pillars that made Part D successful for 20 yearsHow non-interference kept government from setting drug pricesThe IRA as a 16-year Democratic push to repeal non-interferenceWhy Tom calls the IRA price controls disguised as negotiationsThe Trump administration's focus on MFN and Globe Guard pricing340B and the battle between manufacturers and covered entitiesThe Chevron repeal's impact on drug pricing lawHRSA's proposed rebate model and ongoing 340B litigationWhy effective policy means competition, not controlsTom's work helping North Korean defectors and refugeesKey Timestamps1:51 Tom's background at HHS and CMS2:30 The three pillars of Part D's success5:10 Why Democrats wanted to repeal non-interference5:55 Ted Kennedy's compromise and bipartisan votes11:38 The IRA as a 16-year repeal attempt12:03 What the IRA changed in Part D15:02 IRA negotiations vs. real negotiations16:25 How the excise tax makes it no real negotiation21:32 Trump's focus on MFN and Globe Guard25:37 340B's history back to 199128:45 340B as the second-biggest expenditure program29:30 Manufacturer vs. covered-entity acrimony33:18 The Chevron repeal's impact on pricing34:54 HRSA's rebate model, the next step on 340B35:40 The lawsuit over "patient" in 340B38:18 Tom's advice: let competition work39:30 Hepatitis C: competition drives prices down40:34 Competition for gene therapies and CRISPR41:36 Tom's work for North Korean defectors44:49 Sponsoring Free North Korea RadioMedicare Part D, drug pricing policy, Inflation Reduction Act, non-interference clause, 340B program, MFN pricing, Globe Guard pricing, pharmacy benefit managers, covered entities, contract pharmacies, biosimilars, generics, federal drug pricing, government price controls, Tom BarkerAbout the GuestTom Barker is a partner at Foley Hoag in Washington, DC, and one of the country's top drug pricing attorneys. He served as acting general counsel of HHS and chief legal officer at CMS under the Bush administration, where he helped implement Part D from its inception. He is now a go-to expert on drug pricing, and helps North Korean defectors navigate US immigration law.Podcast: DC EKG with Joe Grogan Episode: 136 Guest: Tom Barker Sponsor: Survivors for Solutions - https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio

Mark Denzler breaks down growing concerns over the federal 340B drug pricing program, arguing that a policy originally designed to help low-income and rural patients has expanded far beyond its intent and is now driving up employer and taxpayer health care costs. He explains that hospitals purchase outpatient drugs at steep discounts but often bill insurers at full price, with the spread increasingly concentrated in large, wealthy hospital systems rather than safety-net providers. The discussion highlights claims that employers are absorbing hundreds of millions in added costs annually through higher premiums and deductibles, with similar effects reported across multiple states, including Missouri. The segment closes with broader frustration over health care billing practices, including how insurance-driven pricing, overtesting, and system incentives may be contributing to rising premiums for consumers across the board. Hashtags: #HealthcareCosts #Insurance #340BProgram #Hospitals #DrugPricing #EmployerCosts #IllinoisPolitics #MissouriNews #HealthPolicy #PremiumIncreases

The Trump administration has advanced many policy initiatives in the drug pricing and market access area, and CMS —the Centers for Medicare & Medicaid Services — is the agency at the heart of many of these efforts. Rujul Desai, Senior Counselor to CMS and former Deputy General Counsel at the Department of Health & Human Services, joins Washington, D.C. partner Chris Schott and associate Danny Machado for an update on key CMS priorities. Rujul also discusses the transition from big law to government and shares practice pointers for engaging with the agency.   Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

This podcast explores how the federal government is attempting to lower prescription drug prices by examining the newest most-favored nation-focused drug pricing models, including TrumpRx and the GLOBE and GUARD mandatory models. We discuss how each model is structured and its potential impacts on patients, the healthcare system, and the pharmacy workforce. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Joseph Kleiman, President of Buzz Health, is working to improve price transparency and affordability of prescription drugs. He states that providing price transparency as early as possible in the prescription process is critical for prescribers, patients, and health plans to make better, more cost-effective decisions. To achieve true transparency, all parties in the ecosystem must cooperate and share data, moving beyond pricing visibility to fully integrate systems and use real-time information to improve patient adherence and lower costs. Joseph explains, "Buzz Health really focuses on improving the process behind the scenes, developing technologies that sit within the prescription ecosystem, creating opportunities to improve price transparency, early adoption, and integrated benefits for members."  "We work with everybody from pharmacies to PBMs to payers to employer groups. Anybody we believe has an opportunity that, with technology and early adoption of price transparency and adherence, could benefit them and the members they serve." "What's interesting is that, like most things, the earlier you have information, the easier it is to make actionable change, things with long-term impact. So if you have price transparency and you have it early on, a prescriber can make more informed decisions. A patient, rather than showing up at a pharmacy counter, can make decisions earlier on. So again, it's kind of like the earlier you have anything in making a decision, the easier it is for you to make a really actionable change all the way up through a PBM or health plan. If they see gaps in coverage and they have that information, they can make changes early on as well." #BuzzHealth #PrescriptionDrugs #Pharmacies #HealthcareIT #PriceTransparency #PrescriptionAffordability #PharmacyTech #MedicationAccess #HealthcareTransparency #PrescriptionPricing #PatientCare #HealthTech #PharmacyBenefits #HealthcareInnovation #PatientOutcomes #MedicalTechnology buzzhealth.com Listen to the podcast here  

Joseph Kleiman, President of Buzz Health, is working to improve price transparency and affordability of prescription drugs. He states that providing price transparency as early as possible in the prescription process is critical for prescribers, patients, and health plans to make better, more cost-effective decisions. To achieve true transparency, all parties in the ecosystem must cooperate and share data, moving beyond pricing visibility to fully integrate systems and use real-time information to improve patient adherence and lower costs. Joseph explains, "Buzz Health really focuses on improving the process behind the scenes, developing technologies that sit within the prescription ecosystem, creating opportunities to improve price transparency, early adoption, and integrated benefits for members."  "We work with everybody from pharmacies to PBMs to payers to employer groups. Anybody we believe has an opportunity that, with technology and early adoption of price transparency and adherence, could benefit them and the members they serve." "What's interesting is that, like most things, the earlier you have information, the easier it is to make actionable change, things with long-term impact. So if you have price transparency and you have it early on, a prescriber can make more informed decisions. A patient, rather than showing up at a pharmacy counter, can make decisions earlier on. So again, it's kind of like the earlier you have anything in making a decision, the easier it is for you to make a really actionable change all the way up through a PBM or health plan. If they see gaps in coverage and they have that information, they can make changes early on as well." #BuzzHealth #PrescriptionDrugs #Pharmacies #HealthcareIT #PriceTransparency #PrescriptionAffordability #PharmacyTech #MedicationAccess #HealthcareTransparency #PrescriptionPricing #PatientCare #HealthTech #PharmacyBenefits #HealthcareInnovation #PatientOutcomes #MedicalTechnology buzzhealth.com Download the transcript here  

Washington, D.C. partner Chris Schott, and associates Danny Machado and Evan Rothkoff, share observations and insights from the recent Centers for Medicare & Medicaid Services (CMS) Quality Conference and the American Health Law Association's Institute on Medicare and Medicaid Payment Issues conference. They also discuss updates that government speakers shared at these events.   Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

Nearly one billion prescriptions are abandoned at the pharmacy counter every year, often because patients are blindsided by the cost.This week, co-host Halle Tecco is joined by Wendy Barnes, President and CEO of GoodRx, to discuss the chaos of prescription drug pricing, the murky world of Pharmacy Benefit Managers (PBMs), and how digital tools are changing patient affordability. They break down the layered system of manufacturers, payers, and pharmacies that creates inconsistent pricing, and explore the current push for greater transparency.We cover:The cascade of drug pricing: from initial manufacturer costs and rebates to payer and pharmacy contracts, which results in vast price variability for consumersWhat it would take to get to price transparency in drug pricingThe current pressures on PBMs, including efforts to ban "spread" and the practice of offshoring rebate contracting for tax advantagesWhy pharmacies haven't gone online like other areas of consumer goodsThe future of medication access, including the growth of pharma's direct-to-patient programs and the low current adoption of home delivery despite widespread retail pharmacy closures— About our guest:Wendy Barnes is the President and CEO of GoodRx. She has over 30 years of leadership experience across the pharmacy and medical benefit industry. Most recently, Wendy served as CEO of RxBenefits, where she led the company in providing pharmacy benefit support to more than 2,000 self-insured clients, representing over 3 million lives. Prior to that, she served as President of Express Scripts Pharmacy, overseeing operations for 100 million beneficiaries. Her leadership spans roles at Rite Aid, Premier Inc., and the U.S. Air Force, where she served as a Medical Service Corps Officer. She holds a B.S. degree in Biochemistry from the United States Air Force Academy and an M.B.A. degree from the University of Alaska Anchorage.—

“Innovation is not necessarily a technological breakthrough. It's anything that prevents, cures, or improves quality of life.” — Benoît EscoffierWelcome to Pharma Minds, in this series “Who controls innovation?”, we explore one question in two parts: who controls innovation - and who actually makes it happen.Pharmaceutical innovation exists under constant tension. There is a relentless push-and-pull between access for patients, affordability for public systems, and economic sustainability for companies. So, how do we balance societal expectations with the economic reality of innovation? And what role should pharmaceutical companies play in that balance?In this episode, we tackle this complex equation with Benoît Escoffier. At the time of this recording, he was the General Manager of Daiichi Sankyo France, and he has since been appointed Head of Oncology Value, Access & Pricing Europe & Canada, making this unfiltered discussion about the future of pharma even more relevant today. With over 20 years of global experience, Benoît advocates for a new pharmaceutical model: one built for, and with, society.In this episode, we cover:◾️Redefining Innovation: Moving beyond mere technological breakthroughs to focus on real patient impact, including advancements in oncology (like ADCs).◾️Price vs. Value: A critical look at why the current economic model is too focused on cost and fails to properly evaluate a drug's true collective benefit.◾️Corporate Citizenship: How the pharmaceutical industry can align business performance with strong social responsibility (CSR) and civic engagement.◾️Global Challenges: Navigating the acceleration of the industry amidst AI advancements, geopolitical shifts, and budget instability.◾️The Human Element: A candid discussion on leadership, individual responsibility, and leaving a positive legacy in healthcare.If price reflects value, who ultimately defines that value? Governments? Patients? Industry?

Josh Golden, SVP of Strategy at Judi Health, returns to the Astonishing Healthcare podcast for a timely discussion about the world of drug pricing and what's shaking things up. Josh shares insights from his two decades of experience working with many of our country's largest employers and navigating [very heavy, sometimes scary] pharmacy benefit manager (PBM) contracts. He explains why the industry still relies on Average Wholesale Price (AWP) despite its known flaws, how Maximum Allowable Cost (MAC) lists have been used to drive hidden pricing arbitrage, and why the market is shifting so rapidly toward transparency and alignment.The discussion covers the need for plan sponsors to understand the true cost of pharmaceuticals and how four massive forces are colliding to form "lightning in a bottle" that will drive systemic change in the pharmacy ecosystem. As reforms across the state and federal levels pressure the industry to adapt, plan sponsors must seek forward-thinking PBM partners that prioritize transparent pricing and decisions that benefit the plan and lead to better care for members.HighlightsJosh emphasizes the sordid history of AWP manipulation and explains why it remains a predominant, yet deeply flawed, pricing benchmark in PBM contracts.PBMs frequently deploy MAC lists to extract hidden value, creating wide pricing variations for plan sponsors, pharmacies, and patients.The healthcare industry is moving toward cost-plus economics, making more realistic and reliable pricing benchmarks even more important.Four major trade winds are accelerating PBM reform: state regulations, retail pharmacy closures, transparent cash prices for expensive drugs like GLP-1s, and plan sponsor class action lawsuits.Related ContentWhat is NADAC & How Does It Differ From AWP?Why this benefit leader switched to a more modern, transparent PBMWhat Is the Role of a Pharmacy Benefits Manager (PBM)?Health Benefits 101: The Importance of a Transparent PBM ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.

Health Affairs' Rob Lott interviews James Robinson of the University of California Berkeley about his recent paper exploring most favored nation drug pricing, weighing its feasibility, likely effects on drug launch prices, and implications for global pharmaceutical innovation and investment. Order the April 2026 issue of Health Affairs.

This episode dicusses the role of the 340B Drug Pricing Program in public health infrastructure, state and federal legislative reform of the program, the advocacy role of health systems and pharmacy teams, and the differing views shared by health systems and pharmaceutical manufacturers regarding 340B legislative reform.  Listeners will learn the background and purpose of the 340B program, ongoing efforts to reform the program at the state and federal levels, and what actions are commonly undertaken to influence  reform and the differing views held by 340B stakeholders.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

In this episode, Gabriel Scott, Mark Ogunsusi, and Amanda Smith take a focused look at the 340B Drug Pricing Program, with particular attention to recent developments related to proposals for a 340B rebate model. They discuss why stakeholders may support or oppose a rebate‑based approach to 340B pricing and highlight key considerations relating to such a model.

Based on AHLA's annual Health Law Connections article, this special ten-part series brings together thought leaders from across the health law field to discuss the top ten issues of 2026. In the sixth episode, Mary R. Kohler, Founder & Principal, Kohler Health Law PC, speaks with Kristie C. Gurley, Partner, Covington & Burling LLP, about the targeted reform and broad shifts that U.S. drug pricing is currently undergoing. They discuss issues related to Inflation Reduction Act implementation, litigation, the Trump Administration's approach to drug pricing, pharmacy benefit managers, and 340B. From AHLA's Life Sciences Practice Group.Watch this episode: https://www.youtube.com/watch?v=dIdgAUQA7toRead AHLA's Top Ten 2026 article: https://www.americanhealthlaw.org/content-library/connections-magazine/article/a879dda5-35f9-46fb-ad45-1b0799343d74/Health-Law-Forecast-2026Access all episodes in AHLA's Top Ten 2026 podcast series: https://www.americanhealthlaw.org/education-events/speaking-of-health-law-podcasts/top-ten-issues-in-health-law-podcast-seriesLearn more about AHLA's Life Sciences Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/life-sciencesEssential Legal Updates, Now in Audio AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Comprehensive members. Get all your health law news from the major media outlets on this podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast. Stay At the Forefront of Health Legal Education Learn more about AHLA and the educational resources available to the health law community at https://www.americanhealthlaw.org/.

From Obamacare's limitations to the Bayh-Dole Act, Dr. Abramson reveals how commercial interests overtook public health priorities in research and care. #HealthcareReform #ProfitOverPatients #BayhDole

"Why are we paying $10,000 for a $30 drug?"My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games. Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why We Talk About Cost Instead of Quality (00:02:42) From Silicon Valley & Defense Tech to McKesson (00:10:43) Why Healthcare is NOT a Technology Problem (00:15:53) Fiduciary Responsibility & The J&J Lawsuit (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend (00:23:54) Building an "Open Market" Alternative to PBMs (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies (00:35:42) FDA Approval vs. Real-World Efficacy (00:45:44) How to Actually Fix the Model: The Real-Time "Pause" (00:58:36) Why International Sourcing & PAPs Aren't the Fix (01:11:00) Replacing PBMs with Simple Transaction SoftwareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Why are we paying $10,000 for a $30 drug?"My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games. Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why We Talk About Cost Instead of Quality (00:02:42) From Silicon Valley & Defense Tech to McKesson (00:10:43) Why Healthcare is NOT a Technology Problem (00:15:53) Fiduciary Responsibility & The J&J Lawsuit (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend (00:23:54) Building an "Open Market" Alternative to PBMs (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies (00:35:42) FDA Approval vs. Real-World Efficacy (00:45:44) How to Actually Fix the Model: The Real-Time "Pause" (00:58:36) Why International Sourcing & PAPs Aren't the Fix (01:11:00) Replacing PBMs with Simple Transaction SoftwareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

This Badlands Media special coverage documents President Donald Trump unveiling the TrumpRx initiative and signing executive actions aimed at dramatically reducing prescription drug prices for Americans. The event centers on the launch of TrumpRx.gov, a new platform allowing consumers to access dozens of commonly prescribed medications at steep discounts under Most Favored Nation pricing agreements. The remarks outline how the United States will now pay the lowest price charged for prescription drugs anywhere in the world, ending decades of price disparities. Specific examples are presented, including major price reductions for insulin, inhalers, GLP-1 weight loss medications, and IVF drugs. Administration officials detail how consumers can use the site to obtain coupons and fill prescriptions directly through participating pharmacies. The coverage also highlights commitments from leading pharmaceutical companies to expand domestic manufacturing, the role of tariffs in reshoring industry, and the broader economic and healthcare implications of the initiative. The event concludes with a live demonstration of the TrumpRx website and remarks emphasizing affordability, access, and long-term healthcare reform.

The drug pricing and market access policy space saw a lot of change in 2025, and the pace is not slowing down. In this episode of Connected With Latham, pharmaceutical industry veteran Sabrina Aery, founder of Aery Policy and Access Partners, joins Washington, D.C. partner Chris Schott and associate Danny Machado for a wide-ranging discussion of key 2025 takeaways and what to expect in 2026.   Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

Kristi Martin, a longtime Washington, DC–based policy strategist with deep experience implementing major legislation like the Affordable Care Act and the Inflation Reduction Act, explores how the Orphan Drug Act, passed in 1983 as a bipartisan, patient-driven effort, transformed rare disease treatment by aligning scientific advances, government investment, and market incentives, but that reform may now be necessary—rethinking incentives for blockbuster drugs, refining orphan eligibility, and shifting toward more targeted, evidence-based negotiation.

Health Affairs' Rob Lott interviews Sayeh Nikpay of the University of Minnesota about her recent paper exploring how The Medicaid Drug Rebate Program and the 340B Program interact in ways that can unintentionally increase costs, the adoption of cost-saving strategies to mitigate these interactions, and how policymakers can act to balance Medicaid savings with revenue impacts on 340B-participating safety-net providers.Order the January 2026 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

This week in the Breakroom, Simeon Niles and Amy Kelbick join Maddie News to dive into recent administration announcements and CMMI models related to drug pricing and accessibility.

A New Breakdown on Drug Pricing full 423 Wed, 07 Jan 2026 14:18:05 +0000 TasEhfX3mX7LiSOYmmvfTAohIbc0t0rg emailnewletter,news The Big K Morning Show emailnewletter,news A New Breakdown on Drug Pricing The Big K Morning Show 2024 © 2021 Audacy, Inc. News False https://player.amperwavepodcasting.com?feed-link=https%3A%2F%

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into the significant events of 2025, a year marked by pivotal scientific breakthroughs, regulatory changes, and industry trends that have reshaped drug development and patient care.One of the standout advancements was Novo Nordisk gaining FDA approval for an oral version of Wegovy, a glucagon-like peptide-1 (GLP-1) receptor agonist for obesity management. This marks a notable shift in treatment accessibility, as it provides an easier alternative to injectables for those managing weight and cardiovascular risks. This development could significantly enhance patient adherence and broaden access to this critical therapy.However, not all news was positive. Pfizer faced a challenging situation when a patient death occurred in the extension of their Hympavzi hemophilia study. Such incidents highlight the intrinsic risks of clinical trials, especially within gene therapy realms where safety monitoring is paramount. These events remind us of the delicate balance between innovation and patient safety in advanced biologic therapies.In legal news, Johnson & Johnson was ordered by a Baltimore jury to pay $1.56 billion in a talc-related cancer case. This ruling underscores heightened scrutiny on product safety and consumer protection within the pharmaceutical industry, potentially influencing future litigation and regulatory measures.Clinical trial outcomes also presented mixed results. Neurocrine Biosciences' Ingrezza did not meet efficacy endpoints in its phase 3 trial for cerebral palsy-related dyskinesia. Although it is approved for other movement disorders, this setback reflects the complexities involved in expanding drug indications. Such challenges highlight ongoing hurdles in translating preclinical successes into clinical realities.Despite geopolitical tensions, particularly between China and the U.S., Chinese biotech firms thrived, maintaining robust deal activity. China's continued growth as an innovation hub is driven by strategic investments and collaborations that bolster global drug development efforts, underscoring its increasing influence in life sciences.Regulatory landscapes also shifted with proposals from the Center for Medicare & Medicaid Innovation to align U.S. drug prices with international rates under Medicare Parts B and D. These proposed models could significantly impact pricing strategies and market dynamics within the U.S., requiring pharmaceutical companies to adapt while ensuring equitable access to medications.Ethical challenges surfaced as six individuals were charged with insider trading involving biotech stocks. Such incidents highlight the necessity for stringent ethical standards and regulatory oversight to maintain investor confidence and market integrity.Meanwhile, AstraZeneca's extended partnership with Niowave for actinium-225 supply reflects an interest in radiopharmaceuticals as targeted cancer therapies. This collaboration highlights the potential of radiopharmaceuticals in oncology, opening promising avenues for precision medicine approaches.As 2025 closes, it's clear that this year has been one of both triumphs and trials for the pharmaceutical and biotech industries. Scientific innovations like Novo Nordisk's oral GLP-1 receptor agonist offer new hope for patients, yet challenges such as clinical trial setbacks and legal battles indicate ongoing hurdles in drug development and commercialization. These developments will likely influence industry strategies and regulatory policies as we advance into 2026.The sustained momentum of China's biotech industry amid global trade tensions remains notable. This trend reflects China's strategic investments in biotech capabilities and its growing role in global markets despite geopolitical frictions.In clinical research, Hope BioscienceSupport the show

Trump's drug pricing deals fail patients, media enables plutocratic lies, and Congressman Al Green's affirmation reinforces why truth-telling with solutions still matters.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

Thank you Steven Rosenzweig, Lana Foley, Donna DeMunbrun, Anne Collins, IOLET ELAINE AMBROSE, and many others for tuning into my live video! Join me for my next live video in the app.* Trump's 9 New Prescription Drug Deals ‘No Substitute' for Systemic Reform: “Patients are overwhelmingly calling on Congress to do more to lower prescription drug prices by holding Big Pharma accountable and addressing the … To hear more, visit egberto.substack.com

The pharmaceutical industry has seen major legal and policy changes in recent years, from the Inflation Reduction Act to the Trump administration's aggressive pricing policies. In this episode of Connected With Latham, Mike Domanico, a pharmaceutical industry veteran with experience in Big 4, brand drugs, biosimilars, and generics, and most recently Vice President of Revenue Finance, joins Washington, D.C. partner Chris Schott and associate Danny Machado to discuss how organizations can best respond to the changing environment. As Mike explains, think of meeting the challenge as a loop that connects the business, compliance, and legal in a cross-functional collaboration. Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

This episode announces the launch of CMS's ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model - a groundbreaking payment innovation that enables technology-enabled care organizations to treat Medicare fee-for-service patients with chronic conditions through outcome-aligned payments rather than traditional fee-for-service. Abe Sutton (Director of CMMI) and Jacob Shiff (Chief AI & Technology Officer at CMMI) explain how the model addresses a fundamental gap in healthcare: while commercial and Medicare Advantage patients have access to digital therapeutics and technology-enabled chronic disease management, original Medicare beneficiaries have been left behind. ACCESS changes this by paying providers monthly fees for managing conditions like diabetes, hypertension, obesity, behavioral health issues, and musculoskeletal pain - but only when patients achieve measurable clinical improvements. The model is designed to be deflationary rather than inflationary, encourages innovation by simplifying go-to-market for digital health startups, integrates with existing risk-bearing models like ACOs, and represents a broader CMMI strategy to shift from activity-based to outcome-based payments while leveraging new AI capabilities to democratize high-quality care. (0:00) Intro(0:57) The ACCESS Model: Advancing Chronic Care(4:35) Outcome-Aligned Payments and Technology(7:40) Encouraging Innovation and Investment(09:23) Practical Implementation and Examples(24:28) Evaluating Success and Future Goals(26:18) Connecting the Dots: Broader CMMI Initiatives(28:40) Generous and Its Impact on Drug Pricing(30:11) Challenges and Benefits of Prior Authorization(35:19) The Role of Technology in Healthcare(37:59) AI and Technology-Enabled Care(40:26) Reflections on Value-Based Care Models(43:51) Encouraging Competition in the Healthcare Market(48:24) Quickfire Out-Of-Pocket: https://www.outofpocket.health/

I was out drinking martinis with Cora Opsahl, director of 32BJ Health Fund, and Cora said, "Look, most plan sponsors' biggest expense is health system spend, hospital spend." I know this is an unexpected start to an episode about pharmaceutical pricing and value featuring Sarah Emond, CEO of ICER (Institute for Clinical and Economic Review). But yeah, 50% of most plan sponsors' spend these days goes to health systems. Fifty percent! One half! For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, if a patient who is adherent to a drug and that drug keeps that patient out of the hospital, why do I want to make a patient have excessive skin in the game to get that drug, which everybody knows at this point this "skin in the game" can cause said patient to not be adherent in many cases, cost being a very big reason patients give for not taking medications as prescribed. So then we have this not adherent patient who winds up in the hospital, via the ER often enough. The core issue here that surfaced, bottom line—and I'm not sure if this was in spite of the martinis or as a result of them—but while hospital spend is the largest health expense, high-value drugs that prevent hospitalization often face patient cost sharing and access restrictions, which leads to poor patient adherence and ultimately higher system cost potentially. So then Cora and I spent the next half hour debating when the statement is empirically true and when it's not. And you know what it all boils down to? What's the value of the drug? Do we even know what that means to start? But if it's determined that the drug is relatively high value, then the plan desperately should want to do everything possible to keep that patient on that medication, and cost sharing is a huge barrier to adherence. Today, as I said, I'm speaking with Sarah Emond, CEO over at ICER, and we get into all of this in the conversation that follows. In fact, most of the conversation that follows explores the tensions that exist in the current way that we sell and buy pharmaceutical products. I'm just gonna sum up these tensions in a list here at the top of this show. There's six of them that Sarah Emond and I discussed today by my counting, and each of these we explore in some depth. So, here's the list. Tension 1: The value of any given drug (in other words, what is the fair price for that drug considering the health gains that it delivers) versus the total cost to the plan for the total population taking that drug. GLP-1s have entered the chat. GLP-1s (by ICER's analysis, at least) are super high-value drugs that also can bankrupt plans due to the number of folks who may benefit from taking the drug. Definitely a tense tension to kick off our list here. Tension 2: The list or net price of a drug versus patient access and affordability. Again, this can be tense in an area of much misalignment. You can have a great well-priced drug with huge patient affordability and access challenges because drug net price and coinsurance amounts often have nothing to do with each other. Tension 3: Lifetime value of a drug versus a 3-, 2.5-year, whatever time horizon that many plan sponsor actuaries use in their value assessment. We discussed this today, but there's a Summer Short (SUMS7) on actuarial value horizons with Keith Passwater and JR Clark if you wanna dig in on this further. Tension 4: The tension between the societal value of a drug or even the patient's perceived value of a drug versus what an employer plan sponsor might perceive as the value. What is the formula used to determine value? What's in and what's out? So, that's a bigger conversation just beyond the time horizon for what's included in this calculation. Tension 5: Exacerbating the what's included in the value contemplation beyond just what you include in there is the tension between what is hypothetically of value and what is possible to measure. If you have pharma datasets and medical datasets separate in silos, who knows how many hospital readmissions were prevented by whatever drug? And how much presenteeism or absenteeism exists. I mean, it is an outlier, again, if anyone even knows the net price they paid for a drug, just to level set context here. Tension 6: Lowering financial barriers for patients to take drugs that are of value versus status quo goals and incentives. Like, for example, PBMs (pharmacy benefit managers) are often told that their goal is to reduce drug spend. Okay … so, how do I do that? Oh, reduce access either by prior auths or delay tactics or really high coinsurance, which is gonna reduce adherence by design. And it's someone else's problem—if I'm just thinking like a status quo PBM—if medical spend goes up, right? So, that's our last and not insignificant tension. And look, who comes out the loser in all of these tensions when they get tense? Patients. Not pricing based on value and not buying and setting up cost sharing based on value punishes patients and also plan sponsors or any other ultimate purchaser in the long term, given that the plan is but a population of patients if you start thinking about it in that context. Here is Sarah's advice in a nutshell: Pharma, sell. Pick your price based on something other than market power. And some pharma companies are actually dipping their toe into these waters and doing it. But then PBMs and plan sponsors have to hold up their end of the bargain here and buy drugs based on their value, not just the size of their rebates or some other discounting promise. And then we gotta continue the through line through to member affordability and access. High-value drugs should get preferred. So, right, do a high-value formulary. Listen to the show with Nina Lathia, RPh, MSc, PhD (EP426) on high-value formularies and then listen (after you're done with that one) to episode 435 with Dan Mendelson entitled "Optimized Pharmacy Benefits Are Required if You Want to Do or Buy Value-Based Care." Also, as I said, GLP-1s come up in this conversation, so … yeah, buckle up. One last thing, besides my normal thank you to Aventria Health Group for sponsoring this episode, I am so pleased to thank Payerset for donating to help Relentless Health Value stay on the air. Payerset is a price transparency company with a mission to create fair and equitable healthcare for everyone. Love that. Payerset empowers healthcare organizations, employers, and patients with the most complete set of healthcare price transparency data. They benchmark every negotiated rate and claim and delivering the actionable insights needed for smarter contract negotiations and a more transparent healthcare system. As I have said several times today, my conversation is with Sarah Emond, CEO of ICER. Also mentioned in this episode are Institute for Clinical and Economic Review (ICER); Cora Opsahl; 32 BJ Health Fund; Keith Passwater; JR Clark; Nina Lathia, RPh, MSc, PhD; Dan Mendelson; Aventria Health Group; Payerset; Antonio Ciaccia; Elizabeth Mitchell; Purchaser Business Group on Health (PBGH); Shane Cerone; Sam Flanders, MD; Mark Cuban; Morgan Health; and Tom Nash. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. You can learn more at ICER.org and follow Sarah on LinkedIn.   Sarah K. Emond, MPP, is president and chief executive officer of the Institute for Clinical and Economic Review (ICER), a leading nonprofit health policy research organization, with 25 years of experience in the business and policy of healthcare. She joined ICER in 2009 as its first chief operating officer and third employee and has worked to grow the organization's approach, scope, and impact over the years. Prior to joining ICER, Sarah spent time as a communications consultant, with six years in the corporate communications and investor relations department at a commercial-stage biopharmaceutical company and several years with a healthcare communications firm. Sarah began her healthcare career in clinical research at Beth Israel Deaconess Medical Center in Boston. A graduate of the Heller School for Social Policy and Management at Brandeis University, Sarah holds a Master of Public Policy degree with a concentration in health policy. Sarah also received a bachelor's degree in biological sciences from Smith College. Sarah speaks frequently at national conferences on the topics of prescription drug pricing policy, comparative effectiveness research, and value-based healthcare.   08:18 Why list prices are a lie. 10:59 How does the rebate model sometimes get in the way of paying for value? 12:50 Bonus clip with Sarah Emond. 13:14 EP491 with Elizabeth Mitchell. 13:20 EP490 and EP492 with Shane Cerone and Sam Flanders, MD. 14:37 The tension that is created between affordability and adherence. 15:03 When cost sharing makes sense in pharmaceutical drug pricing. 17:26 INBW42 with Stacey on moral hazard. 18:53 How GLP-1s are "wildly cost effective." 21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value. 22:38 ICER's report on GLP-1s. 26:59 EP385 with Dan Mendelson. 28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs. 29:48 How cost-effective prices are calculated. 31:55 One of the core value underpinnings for value assessment of drugs. 34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report. 36:55 EP426 with Nina Lathia, RPh, MSc, PhD. 38:21 "We can make different choices."   You can learn more at ICER.org and follow Sarah on LinkedIn.   @sarahkemond discusses #pharmaceutical #drugpricing on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW43), Olivia Ross (Take Two: EP240), John Quinn, Dr Sam Flanders and Shane Cerone (EP492), Elizabeth Mitchell (EP491), Shane Cerone and Dr Sam Flanders (Part 1), Dan Greenleaf (Part 2), Dan Greenleaf (Part 1), Mark Cuban and Cora Opsahl

President Trump claims that most-favored-nation pharmaceutical pricing is the ''greatest thing ever'' for patient affordability... but critics of the strategy, including the US Chamber of Commerce, are not convinced (at 14:15) --- Around Town: Cops and Kids will Go Shopping this weekend... it is the signature program of the Fort Findlay FOP Lodge 20 Foundation (at 22:58) --- Remember, Honor, Teach... Organizers are still looking for last-minute donations and volunteer manpower to make the Wreaths Across America program happen locally (at 32:04)

Government pricing assessments are an important tool to help pharmaceutical manufacturers review their government price reporting function. They can also help uncovering strategic benefits and opportunities. In this episode of Connected With Latham, Eliza Biedziak, Managing Director at Ernst & Young LLP, joins Washington, D.C.  partner Chris Schott and associate Danny Machado to explore how these assessments are conducted, the compliance benefits they offer, and the strategic insights they can provide. Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

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The Friday Five for November 14, 2025: iPhone Pocket Brings Back… Pockets. CMS Rural Health Transformation Program Government Shutdown Update Most-Favored Nation Drug Pricing CMS GENEROUS Model   Get Connected:

In this episode of Disruption/Interruption, host KJ interviews Mark Mincy, Chief Commercial Officer at US RX Care, about the hidden complexities and conflicts of interest in the pharmacy benefits industry. Mark shares how his company is disrupting the status quo by demanding transparency, eliminating conflicts, and helping employers reclaim millions in savings. The conversation uncovers the tangled web of PBMs, rebates, and the urgent need for legislative and technological change. Key Takeaways: The PBM System is Riddled with Conflicts of Interest [2:34]Mark explains how pharmacy benefit managers (PBMs) and consultants often act in their own financial interest, not the employer’s or patient’s, leading to inflated drug costs. Rebates and Purchasing Contributions Inflate Drug Prices [8:59]The system of rebates and retrospective payments to PBMs can account for up to 80% of a drug’s cost, forcing manufacturers to raise prices and employers to pay more. Transparency and Fiduciary Duty are Essential for Reform [21:37]Mark’s company, US RX Care, operates with complete transparency, passes back all rebates, and offers per-member-per-month guarantees to eliminate guesswork and conflicts. Employers and Consumers Can Take Action [33:34]Mark recommends joining healthcare purchaser coalitions, hiring ERISA attorneys, and demanding non-conflicted consultants to protect interests and drive industry change. Quote of the Show [31:27]:"Everything's intertwined. You want to move and do the right thing. These employers are between a rock and a hard place, so I do think some legislative action needs to occur." – Mark Mincy Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Mark Mincy: LinkedIn: http://www.linkedin.com/in/mark-mincy-a185497 Company Website: https://us-rxcare.com How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlDSee omnystudio.com/listener for privacy information.

The White House has struck a deal with two more drugmakers: Eli Lilly and Novo Nordisk. Centers for Medicare and Medicaid Services administrator Dr. Mehmet Oz discusses the administration's plan to make GLP-1s more affordable for Americans. Tesla shareholders voted to approve Elon Musk's $1 trillion pay package, as long as he reaches their lofty goals for the company. Musk biographer Walter Isaacson discusses the plan of milestones and Musk's history of exceeding investor expectations. Plus, U.S. airlines are beginning to cancel flights to manage shutdown-strained staffing of air traffic controllers, and Warren Buffett issued a warning on AI.  Dr. Mehmet Oz - 21:43Walter Isaacson - 38:56 In this episode:Dr. Mehmet Oz, @DrOzJoe Kernen, @JoeSquawk Andrew Ross Sorkin, @andrewrsorkinKatie Kramer, @Kramer_Katie Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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The new FDA Commissioner's National Priority Voucher (CNPV) pilot program promises to reduce recipients' application review times from 10-12 months to just 1-2 months. As part of the Trump administration's push for most favored nation (MFN) pricing, drug affordability is one criterion for vouchers, marking FDA's entry into the drug pricing fray. In this episode of Connected With Latham, Washington, D.C. partner Chris Schott and counsel Monica Groat explore the voucher awards in detail and discuss how the accelerated review period might affect launch strategies, whether companies with no voucher will be disadvantaged, and potential risks and concerns. Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Stacie Dusetzina of Vanderbilt University Medical Center and David Simon of the University of Connecticut back to the pod to the current state of drug prices, how proposed tariffs may impact the pharmaceutical industry, that Pfizer deal, what consumers can expect if tariffs are added to prescription drugs, what exactly TrumpRx is, and more.Become an Insider today to get access to our third trend report focusing on the influence of private equity in health care.Related Articles:Trump admin readies 'imminent' probe into other nations' drug pricing, raising new tariff threat: FT (FiercePharma)President Trump's Executive Orders On Prescription Drug Prices: What The Evidence Says (Health Affairs Forefront) Subscribe to UnitedHealthcare's Community & State newsletter.

Pink Sheet Executive Editor Derrick Gingery, Senior Writer Sarah Karlin-Smith and Editor-in-Chief Nielsen Hobbs discuss the reasons US Food and Drug Administration Commissioner Martin Makary could have helped negotiate the Most Favored Nation drug pricing deal with Astra Zeneca (:30) and the deal's potential impact on the 340B program (16:35). They also consider the Justice Department's alternative interpretation of off-label promotion regulations and the effect on the scientific exchange of information about drugs (19:16). More On These Topics From The Pink Sheet US FDA Commissioner's Involvement In AstraZeneca Pricing Deal Raises Ethical, Legal Questions: https://insights.citeline.com/pink-sheet/market-access/pricing-debate/us-fda-commissioners-involvement-in-astrazeneca-pricing-deal-raises-ethical-legal-questions-IJV4LMTDA5E65KCOFQUQM76GCA/ EMD Serono IVF Candidate Among First US FDA Priority Voucher Recipients As Part Of MFN Deal: https://insights.citeline.com/pink-sheet/market-access/pricing-debate/emd-serono-ivf-candidate-among-first-us-fda-priority-voucher-recipients-as-part-of-mfn-deal-LKHA6VRTKRE6DJERGNCWCGMBF4/ Manufacturer Most Favored Nation Deals: How They Could Be Protected From 340B: https://insights.citeline.com/pink-sheet/market-access/pricing-debate/manufacturer-most-favored-nation-deals-how-they-could-be-protected-from-340b-FALSG7GHM5GQBFN3I5SPERJIYU/ Off-Label Promotion: DOJ May Take New Look At Scientific Information Exchange: https://insights.citeline.com/pink-sheet/legalandip/litigation/off-label-promotion-doj-may-take-new-look-at-scientific-information-exchange-R62PQJFQTRBCVGCZE57GWM3Q3Q/

This episode features Paige Twenter, Assistant Editor at Becker's Hospital Review. Twenter highlights three major healthcare stories shaping the industry today, including new H-1B visa fees and their impact on the workforce, Most Favored Nation drug pricing deals, and evolving vaccine mandates and access across the U.S.

Amy Kelbick and Simeon Niles join Julia Grabo to discuss the implementation of President Trump's most-favored nation drug pricing executive order, including how manufacturers are responding and possible next steps.

Stakeholders from across the healthcare industry — from manufacturers and consultants to outside counsel and government officials — recently convened in Chicago for the Medicaid Drug Rebate Program Summit 2025. In this episode of Connected With Latham, Washington, D.C. partner Chris Schott, counsel Nicole Liffrig Molife, and associate Danny Machado share impressions and key takeaways from the conference, including action items like readying litigation support to address likely future challenges. Also check out our bi-weekly Drug Pricing Digest on the website or subscribe to receive future editions in your inbox.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

As the U.S. government has entered a shutdown, Shane drops by to explain the scope of impact, along with next steps with respect to negotiations. Plus, thoughts on yesterday's Oval Office announcement related to drug pricing. Featured is Shane Lieberman, Senior Governmental Affairs Advisors, Government Affairs US. Host: Daniel Cassidy

Countdown to shut down. Washington, D.C. is on alert with less than 48 hours to make a deal ahead of a high-profile Oval Office face-to-face today. Plus, investors are watching from the sidelines, gauging the potential market impact with stocks near record highs. Futures are higher. And later, President Trump keeps the pressure on pharma, with new tariffs coming on the back of a critical deadline today. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this eye-opening episode, Dr. Lindsey Elmore exposes the chaos unfolding in the UK as Mounjaro (weight loss/diabetes medication) prices skyrocket 170% overnight—jumping from £92 to £330 per month. Discover how Eli Lilly's "European price matching" triggered panic buying, crashed pharmacy websites, and left patients spending over £1,000 to stockpile medications. Lindsey examines the real-world impact, even in the U.S.: supply shortages, hoarding behaviors, and the unfair advantage given to those who can afford to bulk-buy versus patients with genuine medical needs. A must-listen for understanding how arbitrary pharmaceutical pricing decisions affect real people's access to life-sustaining medications.Main Topic Introduction00:00-00:30: Discussion focuses on Mounjaro (weight loss/diabetes medication) pricing crisis in the UKThe Price Hike00:37-01:13: Massive 170% price increase starting September 1st, 2025Current price: £92/monthNew price: £330/month (up from planned £122/month)01:25-01:41: Eli Lilly justifies increase as "adjusting prices to match the rest of Europe"Pharmacy Response00:37 & 01:41-02:01: UK's largest online pharmacy "Pharmacy2U" freezes prices, then stops sales entirelyPanic Buying Crisis02:09-02:34: Patients stockpiling medications before price hikes02:22: Pharmacies offering 3, 6, or 9-month bundles02:44-02:59: Real examples: patients buying 7-8 pens, spending over £1,000 in panic purchases04:35: Pharmacy websites crashing from demandSupply Chain Impact02:59-03:24: Hoarding strains supply chains and prevents access for patients who truly need the medication03:24-03:44: Medical experts urge against hoarding injectable medications at homeCore Issues Identified03:51-04:12: Access and fairness concerns - distinguishing between medical necessity vs. cosmetic use05:37-05:57: Drug prices change "for no reason at all" with no patient input06:08-06:27: Need to prioritize patients who medically need medications over those who can afford to stockpileSolutions Proposed04:59-05:27: Work with legislators through existing Inflation Reduction Act framework06:27-06:55: Legislative action needed to control "absurd" arbitrary drug pricing, especially for life-sustaining medicationsEpisode Conclusion07:06-07:14: Show closing: encouraging wise health decisionsBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-lindsey-elmore-show--5952903/support.

Join our co-hosts Todd Eury and Greg Reybold in this exclusive interview with Conor Sheehey, who most recently served as senior health policy advisor to U.S. Senate Finance Committee Chair Mike Crapo (R-ID). In this role, he advised the Committee on a range of health care policy issues, including prescription drug pricing, telehealth, AI, provider coverage and reimbursement, fraud and abuse, medical devices, and Medicare Parts B and D. Sheehey led several bipartisan legislative efforts, including the development of comprehensive PBM reforms and bipartisan proposals on clinician payment reform and drug shortages.

Welcome back to Impact Theory with Tom Bilyeu! In this episode, Tom and Producer Drew dive into a dynamic conversation covering everything from unexpected dinner stories with hip-hop legends and comic creators to deep reflections on global politics, commerce, and the future of technology. Tom and Drew break down Trump's recent deals, cultural realism in foreign policy, the impact of commerce as a global connector, and the blurred lines between healthy capitalism and exploitative systems. SHOWNOTES 00:00 Middle East's Self-Led Transformation 07:39 Cultural Collisions and Misguided Interventions 31:44 Eugenics: Dark Historical Perception 44:36 "Trump's Strategic Move on Drug Pricing" 01:01:45 "Reforming Loan Structures & School Funding" 01:23:07 "Critique of Money Printing Policies" 01:35:17 "Understanding Manipulation in Economics" CHECK OUT OUR SPONSORS Vital Proteins: Get 20% off by going to ⁠https://www.vitalproteins.com⁠ and entering promo code IMPACT at check out Allio Capital: Macro investing for people who want to understand the big picture. Download their app in the App Store or at Google Play, or text my name “TOM” to 511511. ButcherBox: New users that sign up for ButcherBox will receive their choice between steak tips, salmon, or chicken breast in every box for a year + $20 off their first box at ⁠https://butcherbox.com/impact⁠ Monarch Money: Use code THEORY at ⁠https://monarchmoney.com⁠ for 50% off your first year! CashApp: Download Cash App Today:⁠ https://capl.onelink.me/vFut/v6nymgjl⁠ #CashAppPod iRestore:Give yourself the gift of hair confidence this year. For a limited time only, our community is getting a HUGE discount on the iRestore Elite when you use code IMPACT at ⁠https://irestore.com⁠ iTrust Capital: Use code IMPACTGO when you sign up and fund your account to get a $100 bonus at ⁠https://www.itrustcapital.com/tombilyeu⁠  Jerry: Stop needlessly overpaying for car insurance - download the Jerry app or head to ⁠https://jerry.ai/impact⁠ Learn more about your ad choices. Visit megaphone.fm/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Welcome back to Impact Theory with Tom Bilyeu! In this episode, Tom and Producer Drew dive into a dynamic conversation covering everything from unexpected dinner stories with hip-hop legends and comic creators to deep reflections on global politics, commerce, and the future of technology. Tom and Drew break down Trump's recent deals, cultural realism in foreign policy, the impact of commerce as a global connector, and the blurred lines between healthy capitalism and exploitative systems. SHOWNOTES 00:00 Middle East's Self-Led Transformation 07:39 Cultural Collisions and Misguided Interventions 31:44 Eugenics: Dark Historical Perception 44:36 "Trump's Strategic Move on Drug Pricing" 01:01:45 "Reforming Loan Structures & School Funding" 01:23:07 "Critique of Money Printing Policies" 01:35:17 "Understanding Manipulation in Economics" CHECK OUT OUR SPONSORS Vital Proteins: Get 20% off by going to ⁠https://www.vitalproteins.com⁠ and entering promo code IMPACT at check out Allio Capital: Macro investing for people who want to understand the big picture. Download their app in the App Store or at Google Play, or text my name “TOM” to 511511. ButcherBox: New users that sign up for ButcherBox will receive their choice between steak tips, salmon, or chicken breast in every box for a year + $20 off their first box at ⁠https://butcherbox.com/impact⁠ Monarch Money: Use code THEORY at ⁠https://monarchmoney.com⁠ for 50% off your first year! CashApp: Download Cash App Today:⁠ https://capl.onelink.me/vFut/v6nymgjl⁠ #CashAppPod iRestore:Give yourself the gift of hair confidence this year. For a limited time only, our community is getting a HUGE discount on the iRestore Elite when you use code IMPACT at ⁠https://irestore.com⁠ iTrust Capital: Use code IMPACTGO when you sign up and fund your account to get a $100 bonus at ⁠https://www.itrustcapital.com/tombilyeu⁠  Jerry: Stop needlessly overpaying for car insurance - download the Jerry app or head to ⁠https://jerry.ai/impact⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices