Most people think the pharmaceutical industry is either saving the world or robbing it blind. The truth, as usual, is more complicated and more interesting.

In the first episode of The Rx Files, Nancy Lurker and Ken Stone sit down with Jay Galeota, President and CEO of Kallyope, and go straight at the questions the industry usually dodges. Is Big Pharma really suppressing cures to protect profits? Why does a drug that costs pennies to manufacture end up costing hundreds of dollars at the pharmacy? And if 95% of drugs in development never make it to market, why does anyone make that bet in the first place?

Galeota has spent decades inside the machine, starting at Merck before leading multiple biotech companies. He's not here to sell you on anything. He explains, in plain terms, just how brutal the drug development process actually is: years of research, $50 million or more before you've even tested on a human being, and still a 1-in-20 shot at getting to market. Not because anyone is sitting on a cure. Because it's genuinely that hard.

But Nancy isn't letting him off the hook either. She presses on the part that makes ordinary people furious: the fact that Americans pay far more for the same drugs than people in Europe or Canada, that bankruptcy from medical bills is a reality for millions, and that "it's complicated" isn't good enough as an answer.

No easy answers here. But finally, some honest ones.

Next time on The Rx Files: you've heard of Big Pharma. But have you heard of the PBMs? Pharmacy benefit managers sit between you and your medication, and they're making billions doing it. Most people have never heard of them. That's exactly how they like it.

Creators & Guests

• Nancy Lurker - Host
• Ken Stone - Host
• James Galeota - Guest