In this episode, former CMS official Jon Blum reflects on the evolution and impact of the IRA’s drug provisions—from foundational drivers and political trade-offs to how 2026 Part D redesign and the M3P cost-smoothing program are reshaping access. We explore why M3P adoption remains limited, how CMS is monitoring plan behavior around negotiated pricing, and what shrinking standalone Part D options may mean for patients, especially in rural areas. Jon also challenges the “blame game” in Washington—emphasizing the systemic incentives behind each actor—and shares his own prescription for equitably balancing drug affordability, innovation, and policy integrity, including thoughts on MFN and future reform paths.