The Top Line · Fierce Life Sciences

Why patient access must keep pace with drug innovation (Sponsored)

·27 min·2 clips

John O'Brien argues drug spending should be treated as a capital expense, not an operating expense.

1. The Top Line carries a sponsored Health Matters episode, presented with GCI Health, Burson, and Fierce Pharma, on why patient access must keep pace with drug innovation, in a 2026 policy setting. 2. Judy Secker of Burson introduces John O'Brien, President and CEO of the National Pharmaceutical Council, a pharmacist and caregiver who was senior drug pricing advisor in the first Trump administration, and Kristen Cahill, Global CEO of GCI Health, conducts the interview. 3. O'Brien's core thesis is that the U.S. is in a "golden age of biopharmaceutical innovation" yet pays for it with a reimbursement system that treats medicines as "an arbitrage opportunity" to extract margin. 4. He explains why drugs draw so much attention: patients' pharmacy-counter costs depend on tiered formularies and coinsurance based on list price, and nine of 10 researched drugs never reach patients. 5. He says the U.S. spends more per capita on drugs than similar countries but the least among G7 nations as a share of per capita health spending, and that roughly $1 trillion in spending translates to less than half in manufacturer net revenue. 6. He recalls Representative Waxman's line "I love innovation. It just costs too damn much" and argues drugs should be treated as a capital expense that eventually goes generic or biosimilar. 7. On TrumpRX and most favored nation deals, he says direct-to-patient programs expose PBM pricing, such as an employer who called a $750 price on a $1,300 GLP-1 a discount, though importing foreign price-setting would hurt innovation. 8. On the Inflation Reduction Act, he calls the out-of-pocket cap "a godsend" for patients but cites CBO cost overruns, a shrinking standalone PDP market, and a MedPAC note that the law is starting to harm patient access. 9. He endorses the view that "policy risk is at least as great as clinical or scientific risk," and points to Part B maximum fair prices and community oncologists as areas to watch. 10. Health policy, pharma, and communications professionals tracking drug pricing will get the most from this.

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