Healthcare Matters

Our hosts delve into the complex and concerning rise in drug shortages affecting patients in the U.S. and around the world. They explore the intricate economics driving the scarcity of essential medicines, from the impacts of the Inflation Reduction Act to the raw material supply disruptions tied to over-reliance on China. 

Listen as they discuss the severe repercussions on patient care, including delayed treatments and compromised health outcomes, and present thought-provoking solutions that challenge current pricing policies and distribution practices.

Among the highlights in this episode:

01:43: Dr. Popovian lists the three recuring topics he has been hearing about while attending conferences: the Inflation Reduction Act's impact on drug pricing, health care affordability concerns, and drug shortages

02:58: Dr. Popovian explains the perennial nature of drug shortages, highlighting manufacturing issues and the Senate's interest 

03:50: Our hosts cover the range of drugs affected by shortages, from sterile injectables to high-demand medications like Ozempic, and distribution issues for chemotherapy drugs

04:46: Dr. Popovian dives into the economic factors behind drug shortages, including low profitability leading manufacturers to exit the market

07:02: Dr. Popovian shares a personal anecdote about a drug shortage which affected his daughter, emphasizing the consequences for patient care

08:15: Dr. Popovian reminisces about the history of drug shortages, focusing on a significant event a dozen years ago involving pediatric cancer medications

09:17: Conner and Dr. Popovian discuss possible solutions, including rethinking pricing policies to prevent manufacturers from exiting the market, diversifying raw material sourcing away from China, and regulatory safeguards to prevent shortages

12:14: Dr. Popovian shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

In this episode of Healthcare Matters, join our hosts as they dive into the intricacies of the Inflation Reduction Act (IRA). While the act has brought about significant benefits like the annual cap on out-of-pocket costs, zeroing out costs for vaccines, and the insulin cap, it's not without its challenges. 

Join Dr. Popovian and Conner Mertens as they explore the benefits and risks associated with the IRA, offering valuable insights into how it affects patients, particularly in terms of prescription drug costs.

Among the highlights in this episode:

02:12: Dr. Popovian outlines the benefits of the IRA, such as the $2,000 annual cap on out-of-pocket costs, zero out-of-pocket costs for vaccines, and the insulin cap of $35, as well as the negative implications such as the reluctance of pharma companies to release drugs for smaller populations, possibly impacting patients with rare diseases

05:14: Conner brings up the unintended consequences of the IRA, especially its impact on research and development

05:30: Dr. Popovian foresees more step therapy, prior authorization, and potential removal of drugs from formularies as a result of the limitations the IRA imposes on insurance companies and pharmacy benefit management companies

07:21: Dr. Popovian comments on the recent list of drugs to be negotiated by CMS* and points out surprises, such as the inclusion of drugs that will lose their patent before the implementation of set prices

*CMS is the federal agency that provides health coverage through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace

09:40: Dr. Popovian expresses frustration about the lack of rebates and concessions being passed to patients at the pharmacy counter

12:05: Dr. Popovian shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected] 

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected] 

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

In this week’s episode of Healthcare Matters, co-hosts Dr. Robert Popovian and Conner Mertens are joined by special guest, Dr. Shilpa Venkatachalam, Director of Patient-Centered Research Operations and Ethical Oversight at GHLF.

Dr. Venkatachalam’s personal story sheds light on the systemic barriers that hinder patients from accessing crucial vaccines, even when recommended by their health care providers. In this episode, we’ll dig into issues such as state-level regulations, the critical need to expand pharmacist abilities to administer vaccines, difficulties in transferring patient data/information, and the importance of advocating for oneself in the health care system.

Among the highlights in this episode:

02:16: Dr. Venkatachalam delves into the intricacies of her journey with trying to get the Shingrix vaccine as a patient with rheumatoid arthritis, highlighting the system-level barriers patients face, even when vaccines are available

06:30: Dr. Venkatachalam explains the frustration and disbelief of having both the vaccine vial and professionals available but still being unable to get vaccinated, shedding light on the myriad bureaucratic hurdles in the U.S. health system

08:39: Conner empathizes with Dr. Venkatachalam’s story, pointing out how the health care system often makes it more challenging for patients to acquire necessary vaccines, especially in critical situations like Dr. Venkatachalam’s

09:01: Dr. Venkatachalam expands on the emotional and physical toll of not being able to access the vaccine quickly

11:10: Conner and Dr. Popovian discuss potential solutions to ensure patients don’t face the challenges Dr. Venkatachalam went through in accessing preventative care

11:38: Dr. Popovian highlights the broader issue of how state regulations and fragmented patient information contribute to the obstacles faced by patients

15:45: Dr. Popovian highlights the resistance from state medical societies against expanding pharmacists' ability to administer vaccines and how it contrasts with public sentiments about accessibility

19:41: Dr. Popovian emphasizes the importance of data ownership by patients and the challenges posed by data hoarding institutions

20:10: Dr. Venkatachalam offers advice and encouragement, urging listeners not to give up, to advocate loudly, and to reach out to organizations like GHLF for support

22:20: Dr. Popovian shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

In this episode of "Healthcare Matters," join hosts Dr. Robert Popovian and Conner Mertens as they unravel the shady practice known as “copay accumulator adjustors.” Joined by JP Summers, a patient advocate and chronic disease patient herself, they’ll shed light on this practice employed by pharmacy benefit management companies and insurers. You’ll learn how these policies adversely affect patients by preventing patient assistance from applying towards deductibles, leading to financial and emotional burdens. The hosts debunk myths about rising premiums when legislation prohibiting maximizer and accumulator practices is passed, using credible research and data to create an online free interactive tool. Tune in for insightful discussions and personal stories that underscore the urgency of reforming copay accumulator policies.

Among the highlights in this episode:

02:16: Dr. Popovian lays out what a ‘copay accumulator adjustor’ is, and how pharmacy benefit managers and insurers can keep patients from reaching their deductibles using these shady practices. He also explains how they impact patients' out-of-pocket costs.

03:38: Conner provides an anecdote about how these policies look in practice, and how they can impact a patient’s deductible.

04:44: JP shares her personal experience as a patient affected by copay accumulator policies and how it impacted her ability to afford necessary medications. She continues on to show how these practices also negatively impacted her health, her family’s health, and their lives overall. “Never in my life, did I think I would have to choose a loved-one’s health over mine.”

07:11: JP describes the different advocacy efforts she’s undertaken to raise awareness about copay accumulator policies and the impact of her storytelling on creating change. Sharing our stories can be difficult, but ultimately rewarding when it can be used to influence policies that make patient’s lives easier.

08:46: Conner begins exploring the myth that copay accumulator bans will lead to rising insurance premiums. He introduces the GHLF research and data that directly refute those claims. Dr. Popovian explains what the data all means: “What we found…is that there was no statistical differences between states that had passed the bans, and states that hadn’t passed the bans.” He goes on to emphasize that on the state and federal level, there is strong bipartisan support for these bans.

11:15: We hear from Anne Sydor (GHLF Director of Research, Development, and Communications) about where the data was collected from and the transparent methods of analysis for the research presented within the free GHLF tool. She also outlines how patients can know if they are being impacted by a copay accumulator adjustor program.

13:29: Esteban Rivera (GHLF Data Scientist) further explains what the data shows: “…There’s no significant statistical relationship between the passing of legislation, on an increase in premium pricing.”

14:52: Conner shares his closing thoughts on the myth of rising premium costs as a result to passing copay accumulator bans. 

15:31: Dr. Popovian gets the last word on the importance of protecting patients from predatory practices.

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

Join our hosts as they tackle the critical issue of hospital price transparency in the U.S. health care system. Their guest, David Balat, founder of the Healthcare Finance Specialists and an expert in health care finance, sheds light on the impact of hidden costs and the benefits of empowering patients through transparent pricing. Discover how consumerism in health care can lead to lower costs and better outcomes, and learn why price transparency is crucial for improving access to affordable, high-quality health care.

Among the highlights in this episode:

0:57: Dr. Popovian, Chief Science Policy Officer at GHLF, addresses the fact that 41% of U.S. citizens carry some sort of medical debt, with 24% considering bankruptcy to solve the issue

2:20: David Balat outlines his extensive experience in the health care industry, both in hospital administration and policy work

4:35: David discusses the Trump and Biden administrations’ support of the Hospital Price Transparency Rule

5:23: “The hospital industry, the American Hospital Association, fought this rule [the Hospital Price Transparency Rule] tooth and nail, sued it to the highest court and they lost at every level, which we were very, very pleased with. One of the main arguments was people don't really care—people won't use price transparency. And you know, honestly, that may be the case, but it's just been so hard to access that it hasn't been used,” says David

5:43: Dr. Popovian asks David about employers' roles in health care transparency

7:55: David discusses the misconceptions around hospital pricing transparency, emphasizing that a large portion of health care services are elective and can benefit from transparency

8:26: Dr. Popovian and David discuss the potential patient benefits of true hospital price transparency

11:40: David explains how consumerism in health care would benefit patients by giving them control over their care and addressing their financial fears

14:34: Dr. Popovian, Chief Science Policy Officer at GHLF, shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

At the Global Healthy Living Foundation, we know the value of grassroots advocacy. Tune in to this week's episode to hear how trained patient-advocates proactively connect with local, state, and federal health policy stakeholders to share their perspectives and influence change. This week features guests, Corey Greenblatt, Associate Director of Policy and Advocacy, and Patient Advocate and Community Outreach Manager, JP Summers. Alongside co-hosts Conner and Robert, they recount a summer advocacy road trip that spanned more than eight states and dozens of patient-led meetings with lawmakers and stakeholders.

Among the highlights in this episode:

1:31: Corey discusses the reasons for initiating a states tour, the experience of doing so during a post-pandemic period, and the response they received from the policymakers they visited

3:07: “The response from policymakers was overwhelmingly positive. One of the things that we realized through these trips was that patients walk into a door of a legislator’s office… with a net positive rating before they say a word. That's because policymakers and staffers understand the toll that it takes for patients to be there and speak to them and share their stories,” says Corey

3:58: Conner highlights the importance of coalition building

6:18: JP shares her experience with the positive reception from legislators and the empowering feeling of advocacy work

7:53: Corey discusses key policy issues routinely addressed during the tours, with particular emphasis on copay accumulator adjuster laws and pharmacy benefit manager (PBM) transparency laws

10:35: JP elaborates on her personal advocacy experiences in Wisconsin and Texas

12:39: Conner brings up additional key issues such as high healthcare costs, expensive medications, and non-medical costs (such as transportation and caregiver expenses) that affect patients

14:04: Conner shares a key takeaway from the tours, emphasizing the importance and impact of bringing patients' voices directly to lawmakers

15:32: Corey emphasizes the growing awareness of Pharmacy Benefit Managers (PBMs) as influential actors in the healthcare industry, allowing for more focused discussions on specific healthcare issues

16:48: Dr. Popovian, Chief Science Policy Officer at GHLF, shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

We may be on the verge of an enormous shift in how drug prices are set. It’s been led by a dramatic decline in insulin prices, but it’s spreading to other brand drugs as well.

Join our hosts for the first episode of our 4th season as they dive head-first into this important topic. They’ll discuss how this new paradigm is the unintended but welcome result of legislative, regulatory, and market pressures exerted on the biopharmaceutical industry.

Among the highlights in this episode:

1:14: Dr. Popovian, Chief Science Policy Officer at GHLF, tells us about an 85% discount on the HUMIRA biosimilar that has entered the marketplace

1:55: There have been major shifts in the drug pricing paradigm

2:25: Manufacturers of insulin in the U.S. significantly dropped their prices, which will be capped at $35, representing almost an 80% reduction in price

3:10: These pricing shifts aren’t just limited to insulin as we have seen other brand drugs selling directly to consumers at discounted prices in response to significant marketplace pressure

4:00: 4 factors are contributing to drug manufacturers rethinking of pricing models:

1) Litigation and legislative pressure regarding insulin at the state and federal levels

2) The Inflation Reduction Act has wide-ranging implications on drug pricing

3) The removal of the cap for average manufacturer price for Medicaid rebates

4) FTC and Congressional investigations into pricing practices

6:54: PBMs (Pharmacy Benefit Managers) favor rebate contracting, which leads to higher drug prices by increasing kickbacks and despite passing on some of the benefits to employers or plan sponsors, PBMs keep a significant portion of the rebates and fees, causing higher prices to primarily benefit them

9:02: It’s not limited to insulin – other brand products are being sold directly to consumers with success

9:33: The retail biosimilar market is rapidly evolving, especially with the introduction of biosimilars competing against Humira. For example, the biopharma company Coherus recently set a price ceiling for its Humira biosimilar by selling it directly at an 85% discount through a cost-plus pharmacy

11:27: The biggest losers from lower list prices are PBMs, as they will no longer receive significant rebates. Patients are the biggest winners, as they will experience substantial savings when paying deductibles or coinsurance based on the lower retail prices of medications

12:52: Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF, discusses how legislative, regulatory, and market pressures are shaking up the way drugs are priced in the United States

13:23: Dr. Popovian shares some final thoughts

“Are we on the cusp of a new drug pricing paradigm?” - Full article available via the link below:
https://progressivepolicyinstitute.medium.com/are-we-on-the-cusp-of-a-new-drug-pricing-paradigm-fdf611c009b3

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

Join our hosts in this special compilation episode as they revisit some of the most informative and engaging segments from past episodes. They'll discuss drug formulary exclusions and their impact on patients, cash pharmacy models disrupting the industry, and the safety of biosimilars. Tune in to hear valuable insights and advice to help you better understand the ever-changing landscape of health care economics and policy.

Among the highlights in this episode:

1:16: Dr. Popovian, Chief Science Policy Officer at GHLF, explains what drug formulary exclusions are

3:50: When patients are stable on a medication, formulary changes can force them to switch to a different treatment, and while the burden of these changes falls on the patients and their health care providers, Pharmacy Benefit Management Companies (PBMs) and insurers bear none of the risks

6:01: Dr. Popovian states that very little has been done to address drug formulary exclusions on the federal level and suggests that there should be some action taken to hold PBMs and insurers accountable for the consequences of their policies

7:07: Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF, and Dr. Popovian discuss cash pharmacies and how their model can help patients save money on prescription drugs

10:47: “Biosimilars are absolutely safe and absolutely as effective as the brand biologics. FDA has approved these medicines; they go through rigorous research and development process[es]. It takes several years, several 100 millions of dollars to be able to bring these drugs to the market. There is a lot of science that goes behind it, there’s a lot of regulation, there’s a lot of scrutiny, there’s nothing to be worried about [concerning] these drugs” says Dr. Popovian

11:57: Conner explains the importance of looking for verified and peer-reviewed health information as well as trusting scientists and finding the right patient community

13:39: Conner shares information on the importance of advocacy and how to get involved with GHLF’s 50-State Network: “Sign up, tell us your story, and work with us to elevate the stories. We'll give you a megaphone,” he says. More information here: www.50statenetwork.org

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

We are developing policy solutions based on innuendos, gossip, and erroneous modeling assumptions instead of actual data. To help patients with out-of-pocket costs, we need our policymakers to step up, do the brave thing, and improve drug affordability by implementing policies based on accurate data.

In this episode, our hosts dive deeper into the important discussion surrounding transparency in drug pricing and discuss an article published in National Review and co-authored by Dr. Robert Popovian, Chief Science Policy Officer at GHLF. “The reason I authored the paper is because frankly, if you don't have transparency in the marketplace, and you don't have accurate collection of information and data, you're going to make poor policy decisions,” says Dr. Popovian.

Among the highlights in this episode:

2:23: Why transparency is essential in the effort to collect accurate data

3:38: Dr. Popovian explains the complexity of determining how much pharmaceutical spending in the United States falls back into the pockets of pharmacy benefits managers (PBMs)

5:15: Why collecting accurate and precise data is essential to current Congressional efforts on improving and reforming the healthcare system

8:24: Dr. Popovian discusses the opposition that lawmakers and advocates are facing in their efforts on transparency

10:22: “Their arguments [PBMs’ arguments] fall flat because the data doesn't support it. If somebody is paying less for something, then why do you need to increase premiums?” says Dr. Popovian

11:52: Dr. Popovian shares his vision on what policymakers could do to bolster the transparency effort

14:18: Dr. Popovian shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

Over the last 20 years, the United States has made good progress in expanding access to care, yet millions of patients are still struggling to pay for their health care.

In this episode, our hosts discuss current legislation advancements that help protect patient assistance programs concerning their out-of-pocket costs and how patients are being taken advantage of through insurer-initiated programs such as accumulators and maximizers. Our guest, JP Summers, Patient Advocate and Community Outreach Manager at the Global Healthy Living Foundation (GHLF), brings her patient perspective to the discussion having recently met with policymakers in Wisconsin.

Among the highlights in this episode:

1:45: To date, 16 states have passed legislation protecting patient assistance programs

2:28: What are patient assistance programs?

3:25 “On average, out-of-pocket costs for the average patient have been going down in the United States for pharmaceuticals. They [patients] spend less in out-of-pocket costs for drugs today than let's say 10 or 20 years ago. But that's an average. And you have to be careful with averages because what happens is that there is a group of patients who are clearly being harmed by the current policies,” says Dr. Robert Popovian, Chief Science Policy Officer at GHLF

4:22: Dr. Popovian discusses why there is a group of patients who are struggling more than average with health care costs

5:46: The impact of accumulators and maximizers

7:23: Dr. Popovian details some of the legislative advancements made at the state level to better limit health care costs for patients

8:35: GHLF has built an interactive tool to evaluate whether state laws protecting patient assistance programs impact health care premiums: https://ghlf.org/copay-assistance-protection/

9:29: Dr. Popovian explains the pushback from insurers and PBMs (pharmacy benefit managers) against reforms aimed at protecting patient assistance programs

11:02: JP Summers, a patient herself, explains the importance of being a patient advocate

11:44: JP Summers discusses her experience in getting patient assistance from the biopharmaceutical industry

12:23: “I feel that there was a lot of positive things being said [at a meeting JP attended with lawmakers in Wisconsin]. There were several patients besides myself there to advocate to share their personal stories. But what really caught my attention was the press. They were very involved. They were asking questions, and that tells me that they're invested in what we're looking to do in Wisconsin,” says JP

15:03: Dr. Popovian shares some final thoughts

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [email protected]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.