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
  

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 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?
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 Alexander Hardy, President and CEO of BioMarin, to talk about his path to leading one of the world's premier rare disease companies. Alexander reflects on his experience across small molecules, biologics, oncology, and rare diseases, and how his work in access and patient services has shaped his thinking about leadership. We 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. We also 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.

• Alexander Hardy
• PathoGenesis
• Eli Lilly | GSK | Novartis
• Genentech — Access Solutions
• BioMarin — Rare Connections
• AUTHrd Act of 2026 (part of the EPIC Act, HR 1492/S832) — pending before Congress
• Health Technology Assessments in Rare Diseases

Questions or comments? Email comments@prescriptionforbetteraccess.com. Find us on X, LinkedIn, YouTube, and Threads.

In this episode of Prescription for Better Access, we’re joined by William (Bill) Sarraille, a legal expert on drug access and reimbursement. He discusses two developments shaping the pharmacy benefit landscape: the FTC’s enforcement action involving Express Scripts and PBM reforms in the Consolidated Appropriations Act of 2026. Bill explains what these policy changes could mean for benefit design, drug coverage, employer-sponsored plans, and transparency in the PBM market. We also explore potential impacts on formularies, utilization management, contracting practices, and patient out-of-pocket costs, along with possible unintended consequences for employers, manufacturers, and patients seeking timely and affordable access to medicines.

• William (Bill) Sarraille, University of Maryland School of Law
• LinkedIn
• Pharmacy Benefit Managers (PBMs)
• FTC Settlement
• 2024 Administrative Complaint
• Cigna Healthcare
• Fair Market Value in Healthcare
• Consolidated Appropriations Act of 2026
• Part D Plan
• PBMs No Longer Profit From Rebates But Plans Benefit – Pink Sheet
• TPA (Third Party Administrators)
• DOL Proposal
• Copay Accumulators and Maximizers
• Amicus Brief, HIV and Hepatitis Institute

Questions or comments?
Email us at comments@prescriptionforbetteraccess.com.
Follow us on X, LinkedIn, YouTube, and Threads.

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.