In this episode of Healthcare Matters, Dr. Robert Popovian and Ben Blanc sit down with Dr. Alison Bailey, Chief of Cardiology for Centennial Heart at Parkridge in Chattanooga, Tennessee and a Physician Director of Cardiovascular Disease for HCA Healthcare, to explore how policy decisions can help—or hinder—innovation in cardiovascular care.

They discuss the hidden consequences of the Inflation Reduction Act (IRA) for small molecule drug development, the promise of gene-targeted therapies like siRNA, and why medical research funding remains vital for turning new science into life-saving treatments.

Tune in to learn why smarter incentives and stable funding are key to tackling America’s growing cardiovascular crisis.

Among the highlights in this episode:

03:28: Dr. Bailey shares her passion for cardiovascular prevention, emphasizing how patient education and access shape outcomes

04:12: Dr. Bailey discusses the concerning rise in cardiovascular death rates in the U.S. despite advances in treatment, pointing to lifestyle factors and health inequities

05:35: Ben asks about the impact of small molecule therapies in cardiology and how the Inflation Reduction Act may affect future drug development

06:04: Dr. Popovian explains how the IRA’s Maximum Fair Price (MFP) policy shortens market exclusivity for small molecules, reducing incentives for new cardiovascular treatments

08:40: Dr. Bailey expands on how genetically targeted small molecules, like siRNA therapies, are game-changers for cholesterol and rare cardiac conditions, but policy must support their development

10:50: Ben asks about the consequences for patients if companies shift focus away from small molecules. Dr. Bailey warns that fewer innovations could limit treatment options and worsen health disparities

12:15: Dr. Popovian explains how small molecules remain essential for oral medications that improve adherence, affordability, and widespread access—especially in chronic conditions like heart disease

13:00: Ben brings up the bipartisan MINI Act, which aims to align protections for certain targeted small molecule therapies with biologics to maintain incentives for innovation

14:45: Dr. Bailey supports the MINI Act as a practical fix that would encourage more investment in next-generation therapies and benefit cardiovascular patients

16:20: Dr. Popovian highlights the risk of medical research funding cuts, stressing that NIH funding drives discoveries that pharma can’t tackle alone

18:05: Dr. Bailey gives real-world examples of now-standard heart medications that came from decades of NIH and industry collaboration, underscoring the need for stable funding

19:00: Dr. Popovian adds that even widely used generic drugs like beta blockers for heart failure exist today because of federally funded research

20:40: Dr. Popovian and Dr. Bailey agree that more clinician voices are needed to help policymakers see the real impact of drug policy on patient care

22:00: Dr. Bailey closes by stressing that these therapies are not hypothetical—they are real and available now but require supportive policy to reach all patients who need them

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: rpopovian@ghlf.org

Ben Blanc, Director, Digital Production and Engagement at GHLF: bblanc@ghlf.org

A podcast series produced by Ben Blanc.

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.

In this episode of Healthcare Matters, Dr. Robert Popovian and Ben Blanc dive into a recent paper published in the Journal of Health Economics and Outcomes Research that explores the unintended consequences of drug price-setting under the Inflation Reduction Act. Using real-world modeling focused on Eliquis and Xarelto—two widely used anticoagulants—Dr. Popovian discusses how Pharmacy Benefit Managers (PBMs) may shift costs onto patients in response to federal pricing reforms, potentially increasing the risk of treatment abandonment, hospitalization, and death.

Tune in as our hosts break down how pricing policy, rebates, and transparency intersect—and why policymakers must act now to protect patient access.

Among the highlights in this episode:

00:45: Ben introduces the topic of the episode: how new drug pricing rules that aim to lower costs could unintentionally increase out-of-pocket expenses and reduce access for patients

01:12: Robert discusses GHLF’s recent paper, which he co-authored and that was published in the Journal of Health Economics and Outcomes Research, on the potential risks of the IRA’s Maximum Fair Price (MFP) policy

To access he full paper, visit: https://jheor.org/article/125251-could-the-inflation-reduction-act-maximum-fair-price-hurt-patients

02:16: Robert explains how the MFP allows the federal government to set prices for high-spend Medicare drugs and how this disrupts the current rebate model used by PBMs

03:38: Robert describes how PBMs and insurers may respond to lower drug prices by shifting medications to higher formulary tiers or increasing patient cost-sharing to make up for lost rebate revenue

05:10: Ben transitions to the study’s real-world modeling and asks why Eliquis and Xarelto were chosen as the focus

05:42: Robert explains that these two anticoagulants were selected because they are widely used among older adults and come with serious risks if treatment is abandoned

06:55: Ben highlights the human cost of non-adherence and prompts Robert to detail the real-world health outcomes if patients stop taking these drugs

07:23: Robert cites published data showing that increased out-of-pocket costs lead to medication abandonment—and in the case of Eliquis and Xarelto, that can mean higher risks of stroke, heart attack, and death

09:16: Ben asks about transparency in drug pricing and how the current system makes it difficult to understand what patients actually pay

09:38: Robert explains how PBMs deliberately obscure drug pricing, rebates, and patient costs, calling it a “black box” that benefits from secrecy and ultimately harms patients

12:07: Robert calls on Centers for Medicare and Medicaid Services (CMS) to monitor both formulary coverage and out-of-pocket costs for MFP drugs, ensuring that price controls don’t backfire by limiting access or shifting costs to patients

13:20: Robert references a real-time tracking tool from the Pioneer Institute that supports the findings of his study and shows actual increases in out-of-pocket costs for MFP drugs

You can access the Pioneer Institute’s tool here: https://pioneerinstitute.org/the-inflation-reduction-act-ira-overview/

14:59: Robert reinforces that the IRA’s price-setting goals are noble—but without oversight of PBM behavior, patients could be harmed by unintended policy consequences

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: rpopovian@ghlf.org

Ben Blanc, Director, Digital Production and Engagement at GHLF: bblanc@ghlf.org

A podcast series produced by Ben Blanc.

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.