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.

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