Drug Pricing, Broken Incentives, and the 340b program Fixes Washington Won't Touch
About this episode
Ryan Long discusses the structural failures in American drug pricing and the implications of the 340B program.
Episode Summary Ryan Long — former senior policy advisor to Speaker Kevin McCarthy and current non-resident senior scholar at the USC Schaefer Institute — joins Drs. Koka and DiGiorgio for a deep dive into the structural failures driving American drug pricing. The conversation covers the list-to-net price bubble and why patients pay cost-sharing on a fictitious number, how the IRA's price-setting mechanism disincentivizes both new drug development and subsequent indications, and why the 340B program — sold politically as a lifeline for safety net hospitals — systematically funnels the most money to wealthy health systems with high commercial payer mixes. Long argues the fix isn't tweaking the formula; it's scrapping the drug arbitrage mechanism entirely and replacing it with a direct, transparent grant program that actually reaches the hospitals that need it. Chapter Markers 00:00 Introduction — Ryan Long's 25 Years in Health Policy 02:08 Drug Pricing 101: List Price vs. Net Price and Why It Matters 06:39 GLP-1s as a Case Study: Insurance Pullback and the Price War That Followed 11:17 The Medicare Bridge Program and Government Price Setting for GLP-1s 14:11 Why Drug Companies Set…
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