27. Value in Prescription Drugs – What Does It Really Mean?

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

In this episode, we sit down with Kathryn Carey, President, Optum Rx Pharmacy Benefit Manager, to discuss one of the most significant shifts underway in the pharmacy benefit management industry. We explore their new transparent, fixed-fee model, what is driving it, and what it actually means for patients, providers, pharmacies, and manufacturers. We also examine Optum Rx’s digital tools and how they are reshaping the prescribing experience, and the broader effort to reduce friction in patient access. At its core, this is a conversation about whether these changes are early stages of a new model for how medicines are accessed and paid for in the United States.

• Optum Rx
• New PMPM Model
• PBMs Explained
• PreCheck Prior Authorization
• PreCheck MyScript
• Shop MyScript
• Price Edge
• Price Wise
• Savings IQ
• Critical Drug Affordability Program

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In this episode, we interview Stephen Ubl, President and CEO of PhRMA, to discuss what is happening across the industry at a time of significant change. We talk about biopharma’s continued commitment to innovation, what member companies are doing to help patients access medicines more directly, and how new tools from the organization are supporting patient affordability. We also cover the impact of policies like the IRA and MFN, along with the growing focus on PBM reform and other structural challenges in the system. It is a wide-ranging conversation about where the industry is headed and what it will take to ensure the country continues to lead the world in bringing new treatments to patients in need.

• Steve Ubl, CEO of PhRMA
• PhRMA
• PhRMA Leadership Transition
• PhRMA 3 Announcements
• Medicine Assistance Tool (MAT)
• America’s Medicines
• Jim Collins, Building Companies to Last
• FTC Settlement with Express Scripts
• IQVIA Data: Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation
• Most Favored Nation Drug Pricing
• 340B Drug Pricing Program
• New York Times: How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits
• Hatch-Waxman Act

Questions or comments?
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In this episode, we sit down with Alexander Hardy, President and CEO of BioMarin, to talk about his career journey to become the leader of one of the world’s premier rare disease companies. Alexander reflects on his experience across small molecules, biologics, oncology, and rare diseases, and on how his work in access and patient services has shaped his thinking about leadership. We also discuss the policy environment coming out of Washington, including the IRA and other pricing reforms, and how those factors influence long-term innovation and investment decisions. Finally, we explore the real-world challenges facing rare disease patients, employer concerns about high-cost therapies, and what needs to change over the next five years to improve access and affordability.

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In this episode of Prescription for Better Access, we’re joined by William (Bill) Sarraille, a leading legal expert on drug access and reimbursement, to unpack two major developments reshaping the pharmacy benefit landscape: the FTC’s recent enforcement action involving Express Scripts and the PBM reforms included in the Consolidated Appropriations Act of 2026. Bill helps translate what these policy and regulatory changes actually mean for benefit design, drug coverage, employer-sponsored plans, and transparency in the PBM market. We explore how these reforms may affect formularies, utilization management, contracting practices, and patient out-of-pocket costs—and where unintended consequences could emerge. The conversation cuts through the headlines to focus on the practical implications for employers, manufacturers, and, most importantly, patients seeking timely and affordable access to medicines.

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• 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)

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.
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