Prescription for Better Access

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 comments@prescriptionforbetteraccess.com.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 comments@prescriptionforbetteraccess.com. 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 comments@prescriptionforbetteraccess.com. 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 comments@prescriptionforbetteraccess.com. 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 comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

<p>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 &ldquo;importance-to-attention&rdquo; 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.</p> 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 comments@prescriptionforbetteraccess.com.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 comments@prescriptionforbetteraccess.com.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 comments@prescriptionforbetteraccess.com.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 comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In our second of three episodes in conjunction with members of ACCESS Forum, we engage with leading experts to uncover the multifaceted challenges of access and affordability in cell and gene therapies. Our conversation investigates how these treatments' innovative yet complex landscape leads to challenging regulatory pathways, pricing models, and reimbursement strategies.  Alicia Silver, MPP, Head of Cell and Gene Therapy, ADVI HealthEric Faulkner, President, Passage Health AssociatesADVI HealthAlliance for Regenerative MedicineARPA-HBespoke Gene Therapy ConsortiumBlue Bird BioBlue Cross Blue ShieldMedicare DRG RatesNICE (National Institute for Health and Care Excellence)NovartisPassage Health AssociatesREMS ProgramSingle Case AgreementsSpark Therapeutics Medical terminology referenced in this episode: Alzheimer's Aspheresis CAR T therapy Hemophilia Hepatitus C Luxturna Metachromatic leukodystrophy  Myeloablative Conditioning Sickle Cell Disease SMA treatment Spinraza Vaso Occlusive Crises Zolgensma

In this episode, we sit down with leading Market Access experts and members of ACCESS Forum to compare and contrast the drug pricing and access systems worldwide and the US. Our discussion delves into the distinct approaches taken by government vs. private markets, examining how regulatory environments, pricing controls, and reimbursement processes impact patient access to innovative therapies. We explore the challenges each approach faces, from cost pressures to affordability and access, and how they balance the interests of patients, governments, and pharmaceutical companies. Join us for a deep dive into how the global healthcare landscape is evolving and what lessons can be learned. Nikos Maniadakis, Ph.D., Professor, Health Management & Policy, University of West AtticaKimberly Baldwin, Senior Vice President, Value & Access, Ipsen BiopharmaceuticalsFauzea Hussain, Vice President, Public Policy, McKessonCMS (Centers for Medicare & Medicaid Services)European Medicines AgencyHealth technology assessments (HTAs)IRA (Inflation Reduction Act)MedicaidMedicareNational Institute of Clinical Excellence (NICE)NCCN guidelinesP&T committee (Pharmacy and Therapeutics Committee)PAP (Patient Assistance Program)Part B (Medicare)Part D (Medicare)Pharmacy Benefit Managers (PBMs)Quality-Adjusted Life Years TricareVeterans AdministrationMedical terminology referenced in this episode: Cell and gene therapies (CGT) Insulin Orphan drugs Questions or comments?Email us at comments@prescriptionforbetteraccess.com.

In this episode, we explore the evolving role of healthcare and patient advocates and how this profession has become an essential part of the healthcare system. We begin by defining what a healthcare advocate is and tracing the development of the profession over the years. Key milestones are discussed, such as establishing codes of ethics, training, and certification processes. We also share real-world examples of how advocates help patients navigate the complexities of healthcare, making a measurable impact on patient outcomes. The discussion covers the scale of advocacy in the U.S., examining the roles of professional advocates compared to family members and volunteers. We also address how advocates are helping patients overcome barriers to accessing and affording medicines. Finally, we look to the future of advocacy, discussing potential healthcare reforms, the impact of technology, and practical advice for patients seeking an advocate in today's challenging healthcare environment. Rachel Westlake, Managing Director, Coalition of Health Care Advocacy OrganizationsDanielle Marshall, Executive Director, Patient Advocate Certification BoardFred Larbi, Chief Operations Officer, HealthWell FoundationCHCAOPatient Advocate Cerification BoardHealthwell FoundationGreater National AdvocatesNAHACHealthAdvocateXUmbraSolace  Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we explore the evolution and future of the Pharmacy Benefit Management (PBM) industry with insights from two seasoned pharma managed care executives. We discuss the early role of PBMs, their acquisition by pharmaceutical companies, and subsequent industry consolidation. We examine how vertical integration of the PBMs transformed their business model, including the restricted formularies that gave rise to rebates. We also address evolving PBM-manufacturer relationships, the effects of public scrutiny, and predictions for key trends. Join us for a comprehensive look at the past, present, and future of PBMs, focusing on the changes needed to better serve patients. Steve Stefano, Managing Director, ReprizioRx  Steve.Stefano@repriziorx.com Bill Leonard, Managing Director, ReprizioRX wjl@repriziorx.com ReprizioRX PBMs IPA model HMO Medco Metro Containment Services Medicare Catastrophic Coverage Act of 1988 Merck SmithKline Beecham Eli Lilly 340B NDC blocks Group Purchasing Organizations (GPOs)  Medicare United Healthcare FTC CostPlusDrugs Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we dive into the pharmaceutical industry's research and drug development side and the real threat that today’s access and affordability challenges and policies pose to innovation. While innovation often starts in universities with government support, biotech, and pharma companies take on the tough, costly job of clinical trials, development, and approval of new drugs. Investment dollars are limited, only the most promising projects get funded, with an expectation there will be a return. However, our current drug payment process and policies like the IRA have added new considerations for investors, risking fewer new drugs being developed. Without changes, patients could face the closing of our nation's medicine cabinet, with fewer new treatments available. This would be an outcome that would be catastrophic for all of us. Erin Mistry, EVP and Chief Commercial Officer, Cormedix, Inc. Imran Nasrullah, JD., formerly VP & US Head of BD&L at Bayer, and now Founder, SNAP Life Sciences Research and development (R&D) FDA CF Foundation Vertex NIH AMR (antimicrobial resistance) The Pasteur Act HIV Malaria Flagship Pioneering Launches Metaphore Biotechnologies to Unlock the Therapeutic Potential of Biomimicry Novo Nordisk Bets Up to $600 Million on Ozempic 2.0. Here's Why the Stock Is a Buy. Genentech Genzyme (Now Sanofi) Medicare IRA (Inflation Reduction Act) COVID-19 Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

This is the second of two episodes dedicated to Asembia’s AXS24 Summit, where we were honored to be a media partner. In this episode, we learn from Sarah Butler, Chief Commercial Officer of ADVI Health and Lindsay Greenleaf, JD, MBA, Head of Federal and State Policy for ADVI Health how the 2024 election will impact patient access and affordability. Umar Afridi, Founder and CEO of Foundation Health, summarizes his session, From Opaque to Transparent: Transforming the Way We Pay for Drugs. Finally, we get a few minutes with Joe Boswell, the President of ACCESS Forum, leading an effort to create a network for market access professionals. ADVI:Sarah Butler (Chief Commercial Officer)Lindsey Greenleaf (Consulting and Government Affairs Head)R&DInflation Reduction ActNCCN CompendiaPart DCMSPharmacy Benefit Managers (PBMs)Part BFTC and Office of Inspector General (IG)FTC's Section 6B studyFoundation Health:Umar Afridi, Founder and CEOSession: "From Opaque to Transparent: Transforming the Way We Pay for Drugs."Pharmacy Benefit Managers (PBMs)TruepillAPI platformsInternational Access Professional Society:Joe Boswell. PresidentGenMAVAsembia

Asembia’s AXS24 Summit, a pinnacle of specialty drug and healthcare discussions, concluded earlier this month. We are thrilled to share that our podcast was selected as a media partner for this esteemed event. This is the first of two episodes dedicated to AXS24, where Scott and Mark had the opportunity to interview several key speakers and attendees. In this episode, we bring you the insights of Melissa Paige, a seasoned healthcare professional and President of the National Association of Medication Access & Patient Advocacy, who led a session on the Patient Financial Impact of IRA. We also present the perspectives of Renee Rayburg, RPh., VP, Clinical Strategy, Pharmaceutical Strategy Group and Morgan Lee, PhD, MPH, CPH, Senior Director, Research & Strategy, PSG, who are renowned for their study and session on Viewpoints in Specialty Drug Benefit Design. Melissa Paige, President, (NAMAPA)University of Virginia Health SystemAsembiaInflation Reduction ActDr. Madelaine FeldmanRenee Rayburg, Vice President Specialty Clinical Consulting, Artemetrx, Morgan Lee, PhD, Senior Director, PSGPharmacy Benefit Managers (PBMs)GoodRx2024 Trends in Specialty Drug Benefits ReportMedical terminology referenced in this episode:Generic ARBs Multiple SclerosisHumira biosimilarsAlbuterol inhalerEmail us:comments@prescriptionforbetteraccess.com.Follow us on X, LinkedIn, YouTube and Threads.

In this episode, we explore the 340B Drug Pricing Program, an essential yet complex component of the American drug supply landscape that aims to enable healthcare entities to offer more affordable medication to underserved populations. We interview Antonio Ciaccia, a drug pricing and 340B expert who provides an in-depth look at how the program works, its financial incentives, and how stakeholders have exploited this well-intentioned program, all to the detriment of patients. Antonio Ciaccia, President, 3 Axis Advisors and CEO, 46brooklyn Research, an Ohio non-profit Corporation 46brooklyn Ohio Pharmacist Association 3 Axis Advisors Medicaid 340B Program 340B Litigation 340 Eligibility, HRSA Covered Entities Medicaid Drug Rebate Program Obamacare Indian Health Service "Money from Sick People," Report from 46Brooklyn Medicare Pharmacy Benefit Managers (PBMs) Jamie Robinson, Health Economist Medical terminology referenced in this episode: Novolog Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

In this important podcast episode, we interview Victor Bulto, President, US for Novartis, to discuss the company's efforts to develop groundbreaking treatments while ensuring accessibility and affordability for patients. We delve into how the pharmaceutical industry navigates numerous post-FDA approval barriers to launch new drugs and the importance of market access, patient support services, and a commitment by manufacturers to provide patient assistance and other support for patients. Victor Bulto, President, Novartis Novartis FDA Institute for Clinical and Economic Review (ICER) American Heart Association (AHA) Inflation Reduction Act (IRA) Pharmacy Benefit Manager (PBM) Medicare Medical terminology referenced in this episode: Cell therapy: CART-T  Radioligand therapy RNA Entresto Molecular glues Targeted protein degradation Antisense oligonucleotides Small interfering RNAs: siRNAs LDL cholesterol COVID Hematological malignancies Refractory autoimmune diseases Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.

Biosimilars are entering the market at their fastest pace ever. In this episode, we interview a renowned health economist and an expert consultant in biosimilar distribution and patient support to explore the complex landscape of biosimilars, including examining the hurdles and breakthroughs in achieving acceptance by payers and providers and how best to improve patient access and affordability in a market dominated by established brands. Dr. Jason Shafrin, Senior Managing Director, Center for Healthcare Economics and Policy at FTI Consulting Marina Allen, SVP, Fingerpaint Market Access, Patient Support & Access Strategy Leader in Pharma-Biotech Biosimilars The Biologics Price Competition and Innovation Act of 2009 PBMs (Pharmacy Benefit Managers) Medicare Advantage Humira (biosimilars) 340B program Inflation Reduction Act Medicare Part D "brown bagging and white bagging" Mark Cuban (CostPlusDrugs) GoodRx average sales price (ASP) electronic health record (EHR) system Questions or comments?Email us at comments@prescriptionforbetteraccess.com.Find us on social media! Follow us on X, LinkedIn, YouTube and Threads.