We open by marking Yom Kippur and a frank discussion before pivoting to the US 'MFN' drug-pricing moves, what they could mean for Australia’s PBS, and why institutional rigidity in HTA persists and is worsening. Medical research funding rhetoric versus slow progress in PBS and health technology access, hospital funding and NDIS pressures, and the expansion of pharmacist prescribing, as well as the need for subsidised pharmacy services.