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

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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

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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

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In this episode, we interview Brian Reid, the founder of Reid Strategic and the creator and editor of our favorite industry newsletter, the Cost Curve. Brian shares his journey to create the Cost Curve and how he navigates the onslaught of information to identify the most important issues of the day. We also get his take on what he calls the highest “importance-to-attention” healthcare stories, highlighting critical topics that are undercovered related to their significance. We also get the opportunity to understand his perspectives on the threats to innovation, the risks to patient affordability programs, and what all of us should be doing to be better healthcare consumers.

• Brian Reid- Reid Strategic
• Cost Curve Newsletter
• Martin Shkreli & Daraprim
• BioPharma Dive: Biotech and Pharma Industry News
• GLP-1s
• Net Price– “a drug’s net price equals the actual revenues that a manufacturer earns from a drug after rebates, discounts, and other reductions” Source: Drug Channels
• Armamentarium
• Pharmacy Benefit Managers (PBMs)
• Mark Cuban Pharmacy
• Psuedo-Generic Medication
• CVS Cordavis
• Quallent
• Nuvalia
• Biosimilars
• Lilly Direct
• Novo

• 340B Drug Pricing Program

• Copay maximizers
• AFPs

Questions or comments?
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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

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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

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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

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.
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