# Drug Pricing, Broken Incentives, and the 340b program Fixes Washington Won't Touch

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Podcast: [The Doctor's Lounge](https://stenobird.com/podcast/the-doctor-s-lounge-7442524)
Published: 2026-06-20T14:25:26+00:00
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Duration seconds: 3518

## Resource

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 List Prices High at Launch 16:10 The Inflation Reduction Act: Price Controls, Rebate Penalties, and Innovation Risk 20:57 Brand-to-Brand Competition and the FDA's Role 28:52 GLP-1s Under Medicare: Is the $50/Month Bridge Program Good Policy? 36:50 The Medicaid Drug Rebate Program and the Best Price Provision 38:08 The Origins of 340B: What the Program Was Actually Designed to Do 42:24 Qui Bono — How 340B Revenue Is Really Generated 50:17 Contract Pharmacies and the For-Profit Middlemen in 340B 56:31 The Humira Biosimilar Case and the Rebate Trap 1:02:58 The 1987 Supreme Court Case That Superch…

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