In this episode of the Only Healthcare Podcast, hosts Michael Navin and Dr. Randy Vogenberg welcome back Jayson Slotnick for a fast-moving year-in-review of 2025 and a grounded outlook for 2026. The conversation breaks down what changed through the Inflation Reduction Act implementation, why Most Favored Nation pricing keeps resurfacing, and how these policy forces could ripple across Medicare, Medicaid, and employer-sponsored coverage.

Jayson also explores how direct purchasing, transparent pricing models, and the shifting PBM landscape may affect affordability, access, and benefit design. From Part D redesign and underused smoothing to biosimilars, 340B dynamics, and the role of the FDA in driving competition, this episode connects the policy headlines to what employers, manufacturers, and plans should realistically watch next.

Key Topics
• 2025 recap: IRA implementation and Part D redesign
• Drug negotiation timelines and spillover effects
• Most Favored Nation pricing: what is voluntary vs mandatory
• Patient affordability: premiums, deductibles, out-of-pocket pressure
• Employer direct purchasing, net pricing, and PBM disruption
• Biosimilars, patent cliffs, and what 2027 could change
• 340B, hospital economics, and who really benefits from drug money
• FDA’s role: faster approvals, competition, and innovation
• 2026 watchlist: Part B negotiation list, CMS rules, ACA dynamics, CMMI models

Chapters
00:04 Welcome and intro to Jayson Slotnick
02:04 2025 recap: IRA, CMS, affordability pressures
02:45 Predictable vs unpredictable: Part D redesign, MFN momentum
06:22 IRA vs MFN: separate lanes, real-world collisions
09:12 Voluntary MFN models, IRA is not voluntary
12:24 Employer net pricing and direct purchasing trends
16:30 Affordability, hospital costs, and 340B dynamics
18:57 FDA’s role: competition, generics, biosimilars, faster approvals
23:22 2026 predictions: what we know is coming
29:06 Stay current, stay calm, stay focused
31:51 Commercial market changes and employer leverage
39:33 Wrap and where to follow OHP

Michael's LinkedIn

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

In this episode of the Only Healthcare Podcast, hosts Michael Navin and Randy Vogenberg welcome back healthcare policy veteran Deborah Williams for a candid conversation on why 2025 became such a difficult year for employers, patients, and policymakers alike.

Coming off the tensions of the government shutdown and escalating healthcare costs, the discussion breaks down what is actually driving premium increases, prescription drug spending, hospital consolidation, and benefit design changes. Deborah draws on decades of Washington experience to explain why many policy ideas keep resurfacing, why they continue to fall short, and what risks lie ahead as the system moves into 2026.

From direct-to-consumer drug pricing and PBM reform to political gridlock and consumer backlash, this episode explores where healthcare policy may realistically land next and why affordability remains the unanswered question.

Key Topics Discussed

• Why employer healthcare costs outpaced exchange inflation in 2025
• Hospital consolidation and cost-shifting pressures
• Prescription drug spending trends and policy spillover effects
• Direct-to-consumer drug pricing and deductible portability
• PBM reform debates and unintended consequences
• Political gridlock, populism, and healthcare affordability
• What employers, plans, and consumers may face in 2026

Chapters with Time Stamps

00:04 Welcome and episode framing
00:44 Deborah Williams' background and policy perspective
01:44 Why 2025 was a brutal year for employers
03:34 Hospital consolidation and cost shifting
04:35 Prescription drug costs and market pressure
07:15 Consumer behavior, adherence, and affordability
09:00 Political realities and exchange subsidies
12:08 Insurers, public sentiment, and misinformation
14:03 Drug pricing models and global comparisons
16:41 Employer leverage and failed market solutions
17:49 Emerging therapies and future cost risk
20:24 What could improve in 2026
24:26 Populism and the next policy inflection point

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

Recorded live at the Nicholas Hall North American Conference, this special episode of the Only Healthcare Podcast dives into the FDA’s new Additional Conditions for Nonprescription Use (ACNU) pathway and what it means for access, compliance, and the future of consumer healthcare.

Host Randy Vogenberg is joined by industry veterans Bob Stirling and Bob Barron, with questions moderated by Mary Alice Lawless. Together, they break down how ACNU differs from telepharmacy and direct to consumer models, why scale matters, and how built-in safeguards could enable safer nonprescription access to certain therapies, including acne treatments.

The conversation explores compliance challenges, payer dynamics, employer sponsored accounts like FSAs and MSAs, and why ACNU represents a fundamentally different approach to access that could benefit consumers, manufacturers, and plans alike. This episode provides essential context for anyone tracking FDA policy, OTC switches, market access strategy, or healthcare affordability.

Key Topics Discussed

• What ACNU is and how it differs from telepharmacy and DTC
• FDA safeguards and consumer level decision support
• Scale, retail access, and why shelf access matters
• Simultaneous Rx and nonprescription marketing considerations
• Compliance challenges in traditional Rx models
• Implications for payers, coverage, and benefit design
• The role of FSAs, HRAs, and MSAs in supporting access
• Why ACNU represents a new paradigm for consumer healthcare

Chapters with Time Stamps

00:04 Episode overview and ACNU context
01:27 ACNU vs telepharmacy and DTC models
02:48 Simultaneous marketing and provider oversight
03:33 Introduction to compliance and consumer engagement
04:18 Why traditional Rx compliance programs fall short
05:46 Payer and manufacturer cost dynamics
07:05 ACNU as a leadership opportunity for consumer health
07:51 Coverage, payers, and outcomes expectations
08:34 FSAs, HRAs, and MSAs in the ACNU ecosystem
09:57 Pricing stability and consumer affordability
10:45 Key takeaways from Nicholas Hall Conference

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.