Today on the show we take a look at the shadow world where pharmacy benefit managers or PBM’s operate to influence drug prices. Joining us is Antonio Ciaccia, the CEO of 46Brooklyn Research, an Ohio non-profit corporation whose purpose is to improve the accessibility and usability of U.S. drug pricing data.

PBMs are a meaningful part of the US drug supply chain, but until just recently, their outsized role has been hidden in the shadows. Antonio has been on the front lines introducing transparency into the prescription drug marketplace, including just recently in front of the Ohio state legislature.

Kevin Outterson, the Executive Director of Boston-based CARB-X, a global non-profit partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria, joins the podcast to talk with Gunnar about the early-stage landscape for biotechnology companies developing novel antibiotics. Unlike the AMR ActionFund, CARB-X doesn't take equity positions in new companies, but rather provides grants and infrastructure support for companies moving through the drug development process. Gunnar and Kevin also talk about the PASTEUR and DISARM Acts as potential legislative fixes for the antibiotic marketplace. Kevin also points to an assumption that has long been made about generic drugs, which falls short for antibiotics and leaves them in a place that leaves them vulnerable to present market conditions.

The antibiotic resistance series on the State of Health has discussed, at length, the policy and market dysfunctions at the heart of the antibiotic crisis. This week, Gunnar talks with Dr. Ben Chan, an Associate Research Scientist in the department of Ecology and Evolutionary Biology at Yale University, and Ella Balasa, a cystic fibrosis patient advocate who advocates for new options to treat highly antibiotic resistant bacteria. The show details a chance meeting for Dr. Chan and Ella, which led to Ella being one of the first cystic fibrosis patients in the US to dose a phage cocktail fresh out of Dr. Chan's lab work. The two talk about what needs to happen to bring a technology out of academic to patients and how clinical research happens outside of a randomized clinical trial.

Senator Michael Bennet, a co-sponsor of the bipartisan PASTEUR Act, joins Gunnar on the State of Health to talk about his proposed legislation to correct the dysfunctional antibiotic market. Senator Bennet makes his pitch for why he believes people should care about antibiotic resistance, talks about how the PASTEUR Act can become law, and shares how the economics at the heart of PASTEUR differ from current reimbursement practices for antibiotics. Gunnar talks about relying on antibiotics of last resort, how PASTEUR complements another piece of legislation called the DISARM Act, and how new antibiotic options would benefit people living with drug resistant infections.

The State of Health continues the Antibiotic Resistance series with an episode featuring Henry Skinner, the CEO of the AMR Action Fund, a novel kind of investment fund that aims to catalyze the innovation ecosystem for novel antibiotics. Gunnar and Henry talk about the challenges of bringing new antibiotics to market, the difference between the AMR Action Fund and a traditional Biotechnology VC, and the pharmaceutical industry's role in tackling antibiotic resistance. The conversation turns to emerging antibacterial technologies, antibiotic market dynamics and what success means for the AMR Action Fund in the long term.

Earlier episodes in the Antibiotic Resistance Series are in the show's feed!

Senator Todd Young from Indiana joins the podcast to talk about the PASTEUR Act, a bipartisan piece of legislation that he is co-sponsoring with Senator Michael Bennet that aims to reform the way novel antibiotics are paid for in the United States. Unlike most prescription drugs, antibiotics are unique in that they lose their efficacy over time thanks to bacteria evolving to become impervious to antibiotic exposure. PASTEUR is similarly unique because it delinks government reimbursement from prescription volume a pays for novel drugs in the same way you and I pay for our Netflix subscriptions. This episode is part of the State of Health's antibiotic resistance series.

The State of Health is back after a brief summer vacation. This week, Emma D'Agostino, PhD joins the show to talk with Gunnar about their jointly written opinion piece that appeared in The Hill in mid-August entitled: New bipartisan legislation can encourage needed antibiotic development, where they called for bipartisan reform of the antibiotic market. Gunnar and Emma lean on past personal experience with antibiotic resistant infections, their frustrations with the lack of new options and their hopes for how policymakers can reach across the aisle to address the broken incentives at the heart of the reimbursement market that is largely specific to antibiotics.

The episode is the first in an ongoing series about antibiotics and the quest to bring novel technologies to combat the rising threat of antimicrobial resistance.

Katy Monte, an immunocompromised woman who has received three transplants as a result of her end-stage cystic fibrosis, talks to Gunnar about getting a third COVID-19 vaccine after the FDA recommended booster shots for people who may not have developed antibodies after the initial doses. She explains the conversations she had with her care teams, her frustrations with friends who are vaccine hesitant and how her past career as a nurse has informed her choices during the pandemic. Now a mother, she also talks about weighing the risks of pandemic versus her child's development.

Seth Rotberg joins the podcast to talk through the in's and out's of patient advocacy, the patient's role in drug development, and how patients can work with regulators to make sure the best possible medications reach approval. Since Gunnar considers himself a patient advocate, too, they are able to talk about their frustrations with the role, but more important the impact they think patient advocates can have inside the health industry. Seth talks to Gunnar about the frustration that some drug developers have had with taking on Huntington's Disease, while Seth also shares that he has some frustration with how drugs are evaluated for efficacy in Huntington's Disease clinical trials.

In the end of summer 2020, Gunnar sat down to talk with then Lieutenant Governor Spencer Cox about the policymaker's connection with cystic fibrosis and the state's evolving response to COVID-19. Gunnar also solicits a question from a Utahan living with cystic fibrosis for the then Lieutenant Governor to answer. Gunnar talks about the need for social distancing inside the cystic fibrosis community as there is a constant fear around cross-infections for two people living with CF and some strategies for better including people living with chronic illness in state economies.