With the passage of the Inflation Reduction Act by the US Senate, the US is now on the cusp of implementing very aggressive drug pricing controls within Medicare. Richard Evans is the general manager of SSR Health, which he founded in 2009 to address the complexity of US drug pricing. Before founding SSR, Richard was a senior analyst at Sanford C. Bernstein, and during his tenure, he was ranked first by both Institutional Investor and Bloomberg Markets and was also rated as one of the top 20 stock-pickers globally across all large-cap industries. Ironically, one of the most challenging questions to answer in US drug pricing is “How much does it cost?” Is it the cost of the drug out of pocket? Perhaps the cost to the insurer, to the PBM, to the hospital, or the total that finally ends up on the company balance sheet as revenue? To each of these value chain actors, the answer will be markedly different and Richard’s knowledge of the interplay of their various competing interests is without peer. In this podcast, Richard explains the role of PBMs in market access and drug pricing, the perverse incentives that are baked into the US and EU systems, and how all of the actors are simply behaving logically within the odd construct of the current healthcare ecosystems. Often, these outcomes are not aligned to the best interests of patients at the point of sale. As well, we discuss the enormous revenue reductions that are likely to occur within the US biopharma ecosystem if the Inflation Reduction Act is signed into law in its current form, and the ominous implications this has for patients with unmet medical needs requiring cures.  See omnystudio.com/listener for privacy information.