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 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering new digital access to GLP-1 therapies, a clinical trial setback for Pfizer, and the pros and cons of patient portals in connecting with physicians.

 with GiftHealth to expand access to GLP-1 weight loss and diabetes medications through LillyDirect, Eli Lilly’s direct-to-patient platform. The partnership combines Goodpath’s personalized care programs with Gifthealth’s pharmacy distribution capabilities, aiming to make it easier for patients to initiate and maintain therapy. With GLP-1 demand soaring, this collaboration could streamline prescribing and improve adherence, while bypassing some traditional access barriers.

 from a Phase III trial of its sickle cell disease treatment. The therapy failed to meet its primary endpoints, dealing a setback to Pfizer’s rare disease pipeline. The company says it will analyze the data further to understand the outcome and determine next steps. The news underscores the high clinical and commercial stakes in sickle cell research, where effective new therapies are urgently needed but remain difficult to achieve.

 highlights the growing role of patient portals in improving access to physicians, enabling patients to message providers, request appointments, and view medical records online. However, increased accessibility can also lead to a surge in message volume, contributing to clinician burnout and longer response times. Health systems are exploring ways to balance convenience for patients with sustainable workloads for providers, including message triaging and integrating AI tools to handle routine inquiries.

From digital partnerships expanding medication access, to clinical trial challenges, to managing the realities of online patient engagement, these stories reflect the fast-evolving intersection of pharma, technology, and healthcare delivery.

. For more insights on trends transforming pharmaceutical access and care delivery, visit 

Thanks for listening—until next time, stay well and stay informed.

You can catch Pharma Pulse directly on 

This episode of Pharma Pulse covers a new collaboration to expand access to GLP-1 therapies via LillyDirect, Pfizer’s Phase III miss in sickle cell disease, and how patient portals are improving access to care while creating new workload challenges for providers.

Pharma Pulse: GLP-1 Access Partnership, Pfizer’s Sickle Cell Setback, and Patient Portal Trade-Offs

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering three major developments—from new US policy on drug manufacturing to a high-profile pricing change for a leading obesity drug, and new research on vaccine safety.

 directing the creation of a domestic stockpile of active pharmaceutical ingredients, or APIs. The goal is to reduce reliance on foreign sources, strengthen the pharmaceutical supply chain, and ensure readiness for public health emergencies. This policy could have significant implications for manufacturers, potentially accelerating domestic production investments while reshaping global sourcing strategies.

 the UK list price of its GLP-1 drug Mounjaro by 170%. The company attributes the move to aligning prices with the therapy’s value and global market conditions, but the hike has sparked debate over affordability and access—especially as GLP-1 demand surges worldwide. Critics warn that higher prices could limit uptake within the UK’s National Health Service, while proponents say it may reflect the drug’s potential in addressing obesity and diabetes at scale.

 has found no link between aluminum-containing childhood vaccines and adverse health outcomes. Researchers reviewed decades of data and concluded that aluminum adjuvants, used to boost immune response, are safe and do not contribute to chronic illness. The findings are expected to reinforce public health messaging and counter misinformation, particularly as vaccine hesitancy remains a challenge in some communities.

From US manufacturing policy to international drug pricing and reaffirmed vaccine safety, these stories show how regulation, market dynamics, and public health science are intersecting to shape the pharma landscape.

This episode of Pharma Pulse discusses a new executive order to build a domestic API stockpile, Eli Lilly’s 170% price increase for Mounjaro in the UK, and long-term research confirming the safety of aluminum in childhood vaccines.

Pharma Pulse: US API Stockpile Plan, Mounjaro Price Hike in UK, and New Data on Vaccine Safety

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation.I’m your host, and today we’re covering three key developments—from major manufacturing investments to a shake-up in pharmacy customer satisfaction rankings, and shifting insurance coverage for GLP-1 drugs.

to expand active pharmaceutical ingredient manufacturing in the United States. The move aims to strengthen domestic supply chain resilience and reduce reliance on overseas sourcing—an increasingly critical priority for both industry and policymakers. This expansion is expected to boost AbbVie’s capacity to produce high-demand active pharmaceutical ingredients for its branded and pipeline products, while supporting US-based jobs in advanced pharmaceutical manufacturing.

 on pharmacy customer satisfaction reveals that mail-order services and supermarket pharmacies are now outpacing traditional chain pharmacies in patient experience. Consumers cite convenience, better pricing, and shorter wait times as top drivers of satisfaction. This trend could influence prescription fulfillment patterns, with more patients turning to alternative pharmacy channels—particularly as health systems and retailers explore new distribution models.

Lastly, as demand for GLP-1 drugs for diabetes and obesity continues to surge, insurance companies are 

. Some payers are introducing stricter criteria—or even dropping coverage—due to escalating costs and long-term budget concerns. This shift raises questions about patient access and affordability, especially as GLP-1s remain among the most expensive chronic-use therapies on the market. Experts warn that without broader cost-containment strategies, many patients may be forced to discontinue treatment, potentially undermining clinical outcomes.

From bolstering US manufacturing capacity to responding to changing consumer preferences and navigating the economics of GLP-1 coverage, these stories highlight the evolving forces shaping pharma and healthcare delivery.

This episode of Pharma Pulse explores AbbVie’s $195 million investment to expand US API production, new survey results showing mail-order and supermarket pharmacies outpacing traditional chains in customer satisfaction, and rising affordability pressures as insurers restrict GLP-1 coverage.

Pharma Pulse: AbbVie Boosts Domestic API Manufacturing, Supermarkets Lead in Pharmacy Satisfaction, and GLP-1 Coverage Tightens

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering leadership changes at the FDA, new research on COVID-19 risks for childhood cancer survivors, and strategies pharma companies are using to stay competitive as healthcare costs climb.

 of the FDA’s Center for Biologics Evaluation and Research—just weeks after resigning from the post in late July. Prasad, who was appointed in May, stepped down following public criticism from political commentator Laura Loomer, who targeted his past support for Democratic politicians and his role in the temporary halt of Sarepta’s Elevidys shipments.

Multiple media reports indicate his return came at the request of FDA Commissioner Marty Makary, with the White House reviewing the remarks that had sparked controversy. An HHS spokesperson stated that the administration would not allow “fake news media” to distract from the agency’s work.

reveals that adults who survived childhood cancer face a significantly higher risk of severe COVID-19 outcomes. These individuals were more likely to require hospitalization, intensive care, or mechanical ventilation compared to peers without a cancer history. Researchers point to long-term health effects from cancer treatment—such as organ damage and immune suppression—as potential contributors. The findings underscore the need for tailored preventive strategies, including vaccination prioritization and ongoing monitoring, for this vulnerable population.

Finally, with global healthcare costs on the rise, pharma companies are exploring ways to remain competitive while delivering value. Strategies include optimizing supply chains, investing in digital health solutions, and shifting toward value-based pricing models that link reimbursement to real-world patient outcomes. Analysts, including 

, note that companies able to combine operational efficiency with innovation will be better positioned to weather pricing pressures and meet growing demand for affordable, high-quality care.

From leadership shifts at the FDA to new public health research and evolving market strategies, these stories highlight how science, policy, and economics intersect to shape the pharmaceutical landscape.

This episode of Pharma Pulse covers Vinay Prasad’s return to lead the FDA’s biologics center after a brief resignation, new research on severe COVID-19 risks for childhood cancer survivors, and the strategies pharma companies are adopting to stay competitive amid escalating healthcare costs.

Pharma Pulse: Vinay Prasad Reinstated as FDA CBER Head, New COVID-19 Risk Data, and the Industry’s Response to Rising Costs

How recent executive orders—both under the Biden and Trump administrations—have reshaped the drug pricing landscape, and the legal challenges or uncertainties they present for pharmaceutical companies

What life sciences companies should be doing now to proactively prepare for further executive action on drug pricing and market access

The key differences in how executive policies versus legislative actions affect the pharma industry’s pricing and commercialization strategies

The legal and strategic risks executive policy shifts pose to investors and biopharma leaders who may be planning product launches or portfolio expansion over the next few years

Alice Valder Curran outlines the steps manufacturers should take to better prepare for upcoming executive actions on drug pricing and market access.

How Recent Executive Orders Impact the Drug Pricing Landscape

 interview, Vibhu Tewary, project director, IQVIA Institute for Human Data Science, discusses:

Highlights of the company’s report surrounding the “Long-term Market Sustainability for Infused Biosimilars in the US: Foundational Analytics on Emerging Risks to Sustainability”

The process that constructing and piecing together a report of this magnitude entails, along with where the idea itself came from

The ongoing challenges surrounding ASP-based reimbursement

A closed-door, multi-stakeholder virtual roundtable (based on his original report) that was previously held

Vibhu Tewary offers insight on this market segment, including a behind-the-scenes of what goes into designing a report. 

The Path Forward for Infused Biosimilars in the US

 interview, Mark Bouck, chairman and CEO of PharmAlliance, a pharmaceutical and life sciences services platform, dives into:

How PharmAlliance’s acquisition of Complete Health Economics Outcomes Research Solutions (CHEORS) helps expand global reach

The platform’s biggest goal to when it comes to CHEORS and market access services

How CHEORS helps navigate cost-effectiveness and market access hurdles

Acquisitions in the space that are currently in the works

Mark Bouck discusses PharmAlliance’s latest acquisitions, while reiterating its goals surrounding health economics and outcomes research.

Navigating Market Access Hurdles

 interview, Brandon Newman, Xevant’s CEO and founder, explores:

The implications of the Inflation Reduction Act’s price negotiation provisions, and how these could result in ripple effects across the healthcare system

The role that pharmacy benefit managers (PBMs) and other intermediaries' play when it comes to determining drug costs, and how spread pricing is involved

How Xevant helps improve drug cost transparency efforts

Strategies for affordability Newman would offer the pharma industry that can be implemented immediately

Brandon Newman joins The Pharmaceutical Commerce Podcast to discuss the evolving role of PBMs, including the importance of drug price transparency. 

A Further Examination of Pharmacy Benefit Managers

Payer-level reporting should do more than track performance—it must guide strategy, focus resources, and drive measurable brand impact.

Monitoring Payer-Level Performance and Planning

As pharma drug pricing debates heat up, the 340B program faces mounting challenges from outdated regulations, duplicate discounts, and limited transparency. 

340B Litigation and the Path Toward Transparent Drug Discount Programs

Conversation with chief tech expert explores AI’s rise in the support 
space—and separating the substance from the noise. 

Questions Patient Access Leaders Should Be Asking About AI (But Aren’t)

The GSK Flovent example highlights the consequences for patients and pharma of the decision to eliminate the Medicaid rebate cap.

A Rebate Double-Whammy: Exploring the Unintended Consequences 

The online weight loss company launches a $119 starter plan using low-dose semaglutide and behavioral coaching to improve access, reduce side effects, and support sustainable weight loss.

Noom Debuts Microdose GLP-1 Program to Help Reduce Side Effects and Boost Affordability

Gross-to-Net Bubble Reshapes Drug Pricing Strategy

This video was created based on Bill Roth's "Popping the Gross-to-Net Bubble" 

Welcome to the explainer. Today, we are talking about the wild and honestly, super complex world of drug pricing, and we're going to tackle what some experts call the gross-to-net bubble. It's a huge shift that's happening right now, and you need to know about it.

So let's just jump right in with a question that gets to the absolute heart of this whole thing. Why is the price you hear about for a drug—you know, it's list price—why is it basically just an illusion? What's the real story behind that number? Well, the answer really boils down to this one critical term, gross-to-net, or GTN for short. The easiest way to think about it is this. It's the massive and usually invisible gap between a drug's official sticker price and the actual cash a drugmaker gets to keep—all those rebates, discounts, and fees live inside that gap, and they bring the real price way, way down.

Okay, so to really get where things are headed, we first have to understand the old way of doing things, the old playbook for pricing drugs. And let me tell you, it's an approach that has a massive hidden trap built right into it. For years, the logic seemed to make perfect sense, right? A new drug gets approved, what's the first thing you do? You go cut deals with the huge commercial insurance managers, the PBMs. Why? Because they control access to millions of patients. You get in good with them. You get massive volume. Simple, but here's the deep flaw in that logic. When you chase volume with those big commercial players, first, you're ignoring a completely different and incredibly powerful set of rules, government pricing regulations, and trust me, those rules can come back to haunt you and cause your actual revenue to just collapse later on, and we're not talking about some small niche problem anymore.

The ground has completely shifted under everyone's feet. The whole landscape of who actually pays for drugs in the US has fundamentally changed the old rules, they just don't work anymore. This is the number that changes absolutely everything—over 55%. That's how many Americans now get their prescriptions covered by government programs like Medicare and Medicaid. That's not just a big number. That's a tipping point. This new reality is nothing short of a seismic shift. Government payers are no longer just a part of the market. They are the market. They're the majority now. So if you ignore their rules, you're literally ignoring the biggest, most powerful player at the table.

So here's the takeaway—you have to flip the entire model on its head, that old commercial first playbook. It's done. The new game is all about building your pricing strategy on a solid foundation from day one. The 

actually uses a perfect analogy for this. It's like building a house you would never, ever try to put up the walls and the roof before you've poured a solid concrete foundation, right? It would be a disaster in this world. The foundation is understanding all of those government or statutory pricing rules. Then you can think about the commercial deals, the walls and the roof and this new statutory first model.

It's a clear three-step process. First, you have to forecast your patient mix, who's going to be using your drug. Second, based on that, you model the absolute lowest price you can have because of government rules. And only then, as the third and final step, do you start layering those commercial deals on top of that solid base. Adopting this model forces you to ask much smarter, long term questions, you start thinking, hmm, if we raise the price, will that trigger inflation penalties, or wait, if we give this one HMO a super deep discount, could that accidentally set a new best price that we then have to give to the government for free? You see, you're no longer just reacting. You're playing chess, not checkers. And look, this is so much bigger than just a new process for the pricing department, this requires a whole new strategic discipline that has to run through the entire company. It's a move away from just reacting tactically to having a real long-term, enterprise-wide strategy.

So what does this actually look like in a company that gets it right? Well, they have what the experts call mature GTN governance. This means they have high-level steering committees looking at the whole portfolio. They use standardized decision models to avoid making costly one-off mistakes. They're constantly planning for downside risk and making sure that everyone from marketing to finance to legal knows who is accountable for what here's the bottom line, gross-to-net is not just some number that an analyst at a back office calculates anymore. It's a C-suite, top-level priority in today's market, having a smart GTN strategy is one of the most critical factors that determines whether a drug brand lives or dies.

Which brings us to this, final, really provocative question. The commercial PBMs, sure, they might have the loudest voices in the room, but the real rules of the game—those are being written by the government now, and the companies that understand this, the ones who play by those rules first, they're the ones who are going to win.

As over half of Americans now receive prescriptions through Medicare or Medicaid, pharma companies must shift from a commercial-first approach to a statutory-first model, making GTN governance a C-suite priority for long-term brand survival.

Potential 250% Pharma Tariffs Could Pressure Margins Without Directly Raising Patient Costs

, Dave Malenfant, a healthcare supply chain expert, discusses the potential impact of a proposed 250% tariff on pharmaceutical imports, emphasizing that the effect depends heavily on where in the supply chain the tariff is applied. If imposed on active pharmaceutical ingredients (APIs), the impact would be minimal, as APIs contribute relatively little to the total cost of a finished drug and adjustments could be made through negotiation. However, if applied to finished pharmaceuticals or key components—such as bottle plugs, closures, molded parts, and glass—the cost implications could be significant, since these materials represent a substantial portion of overall manufacturing costs.

Malenfant notes that the US conducts much of its pharmaceutical research and development domestically but often outsources manufacturing to lower-cost countries, only to re-import the products for sale. He questions this practice, arguing that products sold in the US should be manufactured domestically to strengthen the supply chain and reduce dependency on foreign production. He cites examples of non-US companies, such as the world’s largest generic drugmaker, establishing manufacturing facilities in the United States as a step in the right direction.

The interview also addresses duty drawback, a current process allowing companies to recover duties paid on imported pharmaceuticals, which the proposed tariff regulation would reportedly eliminate. Without duty drawback, the financial burden on manufacturers and distributors would increase.

While higher component costs could drive up product expenses, Malenfant believes that companies are unlikely to pass these increases directly to patients. Instead, they may absorb the costs by reducing margins, particularly since US pharmacompanies already operate with some of the highest profit margins globally. However, the ripple effect would reach insurance companies, prompting complex negotiations between insurers, distributors, and manufacturers to prevent direct cost increases to patients and maintain access to medications.

He also comments on how the tariff could cascade through the pharma supply chain; the

downstream operational challenges that might arise for pharma companies;mitigation strategies industry leaders should already be exploring; and much more.

If a 250% tariff on pharma imports was to be implemented, what would the immediate cost implications look like for manufacturers, distributors, and ultimately, patients?

It depends where the tariff is applied. If you're talking about the active pharmaceutical ingredients, they'll have very minimal impact, as you get into the royalties and all that. When you look at the cost of a pharmaceutical product, a lot of the cost is not in the active ingredient, as much as the components to package it in the processing. If we are buying a finished pharmaceutical and it's got a 250% tariff on it, and the proposed regulation says that there will not be a duty drawback, because right now, on a lot of pharmaceuticals, you have duty drawback, which means you pay duty upfront, and then you can go and apply to the government and draw back.

What that does is it will have a direct impact throughout the entire supply chain, but at the same time, it's telling the US, why aren't we making these pharmaceuticals in the United States? Most of the research and development has been done in the United States, but then we export it out to cheaper countries to make the product, and they import it back in, such as Singapore—I’m not going to talk about India, because India is a unique situation—or other countries, and then we import it back in trying to distribute it within the United States. Good FDA approval and distribute in the United States. I'm not proponent of that. I think if we're going to sell in United States, I firmly believe that we should make it in United States.

An example, Nico, is the largest generic pharmaceutical company in the world is not American, but yet they're now manufacturing in the United States. My view is that, depending on where in the process, is that duty going to apply? Now it says it's going to apply throughout any pharmaceutical, including active pharmaceutical ingredients, components, and manufacturing, but if it's raw materials, active pharmaceutical ingredients will have a very minimal impact on anything, because we can make adjustments in the way we negotiate it.

If it's components like bottle plugs, closures, molded parts, glass, that has a bigger impact, because that is the one of the bigger costs within the main total cost of a pharmaceutical. That will probably increase the cost of the product. Does it mean it's going to be a price increase? I don't believe so. I think the companies will eat it up in their margins, because here in the United States—and I know some of the listening audience will probably not like me saying this—but the US enjoys the largest margins in pharmaceutical drugs in the world.

Having the tariffs, you have to decide, do we eat it in margin, or do we pass it on to the consumer? By the way, it doesn't really get passed on to the consumer, it gets passed on to the insurance companies, and the insurance companies certainly are not going to accept it, so the network is going to be disrupted, and there's going to be a lot of negotiations between the partners, between distributors and insurance companies, to offset it so that there is not a direct impact to the end patient.

In the first part of his Pharma Commerce video interview, Dave Malenfant, a healthcare supply chain expert, explains how steep pharmaceutical import tariffs might affect costs at different points in the supply chain, why component pricing poses a bigger risk than active ingredients, and how insurers, distributors, and manufacturers may negotiate to shield patients from price increases.

How Pharma Can Remain Competitive Amid Rising Healthcare Costs

, Philip Sclafani, PwC's pharmaceutical and life sciences lead, he describes how the One Big Beautiful Bill Act (OBBBA) is expected to significantly influence prescription drug spending by reshaping access and reimbursement within Medicaid, certain Medicare segments, and ACA exchange plans. The OBBBA introduces pressure on pharmaceutical revenues, particularly by limiting coverage for high-cost drugs in publicly funded markets. This could reduce patient access to specialty medications and diminish pharma sales in those sectors.

Simultaneously, broader market forces are also impacting prescription drug trends. On the private commercial insurance side, cost inflators like the rapid growth of GLP-1s and behavioral health treatments are emerging, while biosimilars act as deflators. The intersection of these trends—OBBBA and private market shifts—presents a complex environment for pharmaceutical companies.

To mitigate financial risks and preserve innovation, pharma firms are being pushed to accelerate R&D investment and pursue mergers and acquisitions (M&A) that bring in near-term revenue and long-term pipeline potential. There’s also growing interest in global licensing deals, including accessing drug pipelines from China for US or ex-China markets.

At the operational level, companies are responding to tighter margins by improving efficiency—through digitization, AI integration, and reevaluating commercial spend, such as Salesforce deployment and direct-to-consumer marketing.

Overall, Sclafani emphasizes that OBBBA is just one factor within a larger industry shift, and successful pharma companies will need to respond holistically—balancing cost containment, innovation, and strategic partnerships to adapt to this evolving landscape.

He also comments on balancing the demand for innovation with increasing payer pressure to control costs; the role biosimilars play in long-term cost containment strategies; operational and pricing strategies pharma executives should prioritize in order to stay competitive while ensuring patient access and affordability; and much more.

With healthcare costs projected to remain elevated at 8.5%, what operational and pricing strategies can pharma executives prioritize to stay competitive while ensuring patient access and affordability?

It's a challenging time with health costs not really sustained on this increased path, and sometimes, I think the medical cost trend can be misinterpreted. It never has decreased in the time we've been doing this. It's just lower rates of inflation or higher rates, and we're in this period of high inflation.

I'd say one thing—if you look back over the time period when we see this consistent higher healthcare increase trend, we have tended to see legislation or major policy shifts try to come in place as sort of macro deal with those. I think it remains to be seen if we'll see another bill coming this year, and that's certainly one thing pharma’s looking out for. We had the OBBBA now, and maybe there'll be more. But historically, you look back at the highest cost times, the Affordable Care Act came, or during COVID, there was the Cares Act. Obviously, that was a once-in-a-generation event, hopefully limited, once in a 100-year event, hopefully, but we saw some legislation there.

I think that's one of the big watch outs that will both impact pharma and pharma will respond to is because we're in this period of multiple years of higher almost getting up to 10% costs increases, might we see some more government intervention? Potentially, outside of that, there are levers we expect to see pharma companies pull. I think I mentioned a few before, but thinking about optimizing commercial operations to be as lean and tech-driven as possible, that's going to take some time in different areas, but optimizing the supply chain is probably a very timely question. Thinking about the tariffs that were just announced in the EU and so far, expect to impact pharmaceutical products, that's another major inflator. Pharma will have to look at strategies to onshore, in order to optimize the supply chain, things like that, to just even prevent terrorists from further raising prices in the market.

We think about really focusing on innovation. I think pharma companies already spend a lot of time on health economics and what it means. There's no question that the direct cost of a pharmaceutical, a prescription drug, increase cost as soon as it's dispensed and taken by the patient. The goal, though, is that will get those patients stable to whatever the clinical goal is, which will have an impact on health economics and costs going forward. Engagement with payers and PBMs is always critical as much as possible, trying to get to the collaborative solutions and less back and forth over prices and rebates.

It's always going to be there, but what's the right balancing act? What is the population that should be insured and covered for this treatment at that negotiated price that's going to get there? I think for pharma, if you look at it, there is no way to price increase your way out of these challenges; there are price protections and commercial agreements. There are CPI-U penalties, Medicaid, and now, Medicare inflationary penalties. There's very limited value in increasing prices. It's really focused on, how do I get to more efficient operations on the L side of the P&L, and how do I get to the right sort of coverage and value equation with different payers and PBMs here in the US, not too dissimilar from what happens in a lot of European countries. You have to do it a whole bunch of times here in the US, versus one national health technology assessment, all of that. We don't have that model here, but I think you're still assessing how many patients will be covered at what price, getting to what value.

In the final part of his Pharma Commerce video interview, Philip Sclafani, PwC's pharmaceutical and life sciences lead, discusses operational and pricing strategies pharma executives can adopt to navigate sustained cost inflation, including supply chain optimization, payer collaboration, and value-based approaches to ensure patient access and affordability.

How Pharma Can Navigate Innovation and Cost Pressures in the GLP-1 Era

How can pharma balance the demand for innovation with the increasing payer pressure to control costs?

That is the balancing act that we're trying to achieve, and what I would say for years. We're at a point now where specialty medications make up, 2% of overall prescribing, but 50% of cost. There is no true generic of a biologic. We're starting to see biosimilars now become important and actually delivering cost savings as of last year, so that will help. What's historically happened is pharma has innovated and brought out new therapies that address unmet needs or raise the standard of care. Those small molecules grew to be big brands and then eventually, lost patent and generics came in and significantly—almost overnight—reduced the cost of those to pennies in some cases, and then the next round of innovation would go.

The machine ran that way for a while. Over the last two decades or so of biologics coming in, you have that continuing dynamic on the small molecule side, but then biologics were adding new costs to the system, and there really wasn't a generic. Many therapies have existed long past their patents expiring. I'd say that's one of the big factors now is biosimilars as a deflator.

The equivalent of generics on the small molecule side are beginning to meaningfully reduce the cost of those. If you were to extract out the growth of GLP-1s, and then just look at the rest of the market, it's actually pretty flat for pharmaceutical spend, going down because of the major biosimilar events last year. I think that's one big piece.

I think GLP-1s as a major driver, there’s probably two parts to it. One is a lot of is a utilization story. How many patients actually have insurance coverage for it and will get access to it, and how long will they stay on therapy that's driving a lot of the cost? In many regards, the net cost of these therapies is actually coming down over time as that access expands. That's probably the 100-billion-dollar question: how big will GLP-1s become? Big, I think, is the answer for most, but how many patients will have access to it, and what will that use look like?

I think the expectation is that will grow. There will even be small molecule. There will be generics of those, or generics/biosimilars of the GLP-1s coming, some of them are selected for IRA negotiation under Medicare that will reduce costs. I think part of is that balancing act and nothing new for health plans and insurance companies. As the prices come down a little bit, they can incrementally reduce some of the utilization management and expand access and coverage, and some of this also goes back to an employer choice to being willing to cover those therapies.

That’s kind of the near-term story. I think the longer-term story is, I don't think health insurers are interested in paying for patients to have a lower number on the scale—it's more about, does it improve overall healthcare, cardiovascular health, etc., and reduce costs? That's going to take some time to bear out. The tough trade-off is, do I pay for obesity and weight loss management now to see some of the broader medical and health plan cost savings later?

I think that’s the hope you'll see there, and eventually, that should catch up. And then the last piece I'll say is there are other areas in neurosciences, Alzheimer's, Parkinson's, depression, new treatments coming out as well that that will gain hold and eventually, incrementally increase costs, but again all part of that balancing act of some things are coming down from generics and biosimilars. There'll be new innovation that likely will cost more, but then should have some longer-term cost savings, especially in the case of GLP-1s. I think that's kind of the virtuous cycle we're watching for now.

In the second part of his Pharma Commerce video interview, Philip Sclafani, PwC's pharmaceutical and life sciences lead, discusses how the pharmaceutical industry is balancing high-cost innovation, especially in obesity and metabolic disease, with payer demands for cost containment, highlighting the growing role of biosimilars and future generics in offsetting spend.

Facing a Crossroads

He also comments on balancing the demand for innovation with increasing payer pressure to control costs; the role biosimilars play in long-term cost containment strategies; operational and pricing strategies pharma executives should prioritize in order to stay competitive while ensuring patient access and affordability;

How do you foresee the One Big Beautiful Bill Act (OBBBA) reshaping prescription drug spending, and what strategies should pharmaceutical companies adopt to mitigate its potential impact on innovation, R&D investment, and M&A activity?

Starting out with the One Big Beautiful Bill, I kind of look at a couple things that are happening at the same time. The OBBBA passed, and that's primarily impacting the government side of things, so Medicaid, a little bit of Medicare, and then the ACA exchange plans. At the same point, a happy coincidence—at the same time, we put out our “Behind the Numbers Medical Cost Trend Report,” and that's primarily looking at the private commercial insurance market.

There are significant trends and inflators going on over there, with the rise of GLP-1s and some behavioral health neurosciences, as well as some deflators, with the biosimilars coming in and having an impact. I focus on the totality of it. If you look at all the big trends, that's really what's driving a lot of pharmacy benefits and prescription drug strategies. If you look at pharma companies from multiple angles facing potential loss of sales, having less patients insured on the Medicaid side and ACA exchanges certainly will impact the availability of those patients to use, access, and pay for prescription drugs, particularly specialty medications. Regarding higher cost, there'll be a challenge there.

We think about those patients, unfortunately not being able to get all the prescriptions they would want, spending and pharma company revenues going down there. On the other side, we do see significant innovation coming in from newer therapies, obviously GLP-1s continuing to grow, and others. So I think it's important to look at the totality. It's a challenging environment.

From an overall gross-to-net perspective, pharma continues to pay more discounts and rebates and things like that to payers, PBMs, health plans, hospital systems, etc. And then on the other end, you've got One Big Beautiful Bill reducing access and coverage, which could be a challenge. I think the natural response you look at is there is a near-term revenue gap for some, so that's prioritizing and accelerating R&D investments, looking at M&A activity that adds revenue now, but also has some longer-term either indication expansion or pipeline potential.

We also see some innovative deals starting to access molecules or pipelines from China that potentially could be brought to the US or ex-China markets. And then the last piece, I think, whenever you have this kind of revenue and profitability push, there's a natural look to get more efficient in operations. Some of that is digitizing the operational core of the company. We see a lot of AI and other use cases in there. In other cases, it's reevaluating, just overall, you know, how much are we spending on Salesforce, DTC, other things like that. I think you see a little bit of push from both, and One Big Beautiful Bill is certainly one piece that fits into the overall picture driving that.

In the first part of his Pharma Commerce video interview, Philip Sclafani, PwC's pharmaceutical and life sciences lead, shares how he foresees the One Big Beautiful Bill Act reshaping prescription drug spending, and what strategies pharmaceutical companies adopt to mitigate its potential impact on innovation, R&D investment, and M&A activity.

Scaling Obesity Drugs Responsibly

, Hyung Heon Kim, CEO of MetaVia, describes how the current US payer ecosystem, including commercial insurers and Medicaid, exhibits a divided approach when it comes to supporting access to obesity medications. Coverage largely depends on whether obesity is accompanied by additional health complications. He explains that there are essentially two categories of patients: those who are obese without any complications and those who are overweight or obese with related conditions, such as type 2 diabetes or Metabolic Dysfunction-associated Steatohepatitis (MASH).

For patients who fall into the second category—those with complications—insurance coverage is typically available. This is because obesity-linked conditions like type 2 diabetes are recognized as serious health issues that require treatment. Payers are prepared to provide coverage in these cases, acknowledging the need for medical interventions that go beyond lifestyle changes alone.

However, for individuals who are obese but otherwise healthy, coverage remains limited. Kim highlights that the current administration does not fully recognize obesity as a disease on its own, instead viewing it as a condition that can be managed through lifestyle interventions, such as diet and exercise. This perspective means that insurance companies are less inclined to cover obesity medications for patients who do not have related health complications.

Kim suggests that this approach overlooks the broader benefits of proactive obesity treatment, which can prevent complications before they arise. While insurers and Medicaid seem prepared to handle cases with associated conditions, they are not yet structured to provide long-term affordability and access for individuals seeking preventive care solely for obesity. In essence, the payer ecosystem is ready for treatments tied to co-morbidities but lacks readiness and policy alignment for covering obesity medications in otherwise healthy patients.

In the fourth part of his Pharma Commerce video interview, Hyung Heon Kim, CEO of MetaVia, explains the market dynamics or stakeholder misalignments that need to be resolved in order for the next generation of weight-loss drugs to reach scale without overburdening payers.

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