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Welcome to the Road to Care podcast hosted by SamaCare, where we'll talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today. And where we see it evolving some care's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together we can simply make things right.
Kip Theno: Okay, welcome back to The Road to Care podcast everybody and happy 2026. I can't believe it's here. As you can see, we've got a brand new studio. We've got fancy headphones we've splurged for, uh, and, uh, we're looking forward to a great show. We've got a panel of three doctors today and our CEO, Syam Palakurthy.
Our panel Dr. Amitabh Singh, Dr. Indranil Bagchi, and Dr. Cristina Masseria. Dr. Singh is a highly experienced and accomplished leader in [00:01:00] market access, health, economics, and real-world evidence generation.
With nearly 30 years of experience in major pharmaceutical companies such as AbbVie, Wyeth, Pfizer, and Novartis, Dr. Singh is passionate about building scalable and groundbreaking capabilities to enhance value, differentiation, and demonstration. And a proven track record of leading successful teams in areas such as value and access, pricing and reimbursement, and evidence generation.
Dr. Singh has an M. Phil. in international trade and econometrics, and a PhD in economics. Dr. Singh retired two years ago in his final position, he held the role of Worldwide Head and vice president of HEOR, in Novartis oncology.
Dr. Bagchi currently serves as global head of pricing and market access at GSK, where he drives overall strategy on value demonstration, and market access across all product areas.
In the GSK portfolio, Dr. Bagchi has extensive experience and proven track record of leading value and access pricing, [00:02:00] reimbursement, and health outcomes functions in major companies, including GlaxoSmithKline, Wyeth, Pfizer. Novartis, Dr. Bagchi has an MS in healthcare administration and a PhD in pharmaceutical socioeconomics.
Dr. Masseria currently serves as vice president of value and access for AESARA, a digital forward market access agency. Prior to that, Dr. Masseria served as vice president patient health and impact hospital and vaccine business units at Pfizer and worked in health outcome vaccines. At GSK. Dr. Masseria began her career in academia.
As a health economics researcher and lecturer at the London School of Economics and Political Science LSC. Dr. Masseria has an MSC in health economics and a PhD in economics.
I do want to take a quick minute to thank Jillian Kushner (jfactor.com), our program director, all our listeners. Our viewers and subscribers and of [00:03:00] course our guests in 2025 making R2C Road to Care podcast, one of the top healthcare podcasts in the country. Um, and as we do, sometimes I will not just be the host with the microphone.
I'm going to pass that golden mic, the torch, over to Syam Palakurthy, our CEO of SamaCare to start with the intros and have a robust discussion. So welcome back everybody.
Syam Palakurthy: Great. Well, thank you Kip and thank you everyone for listening. We are super, super excited about this conversation today. We have not just a panel which is new for us, but also a panel of absolute global pharma All Stars. They have seen so much, across so many different regulatory landscapes and so many different, drug launches. So real excited for this. Maybe I, will start with having, each of the three of you just tell us a little bit about your background. What drew you to healthcare in the first place and, and to health economics and into market access. Amitabh, let's start with [00:04:00] you.
Amitabh Singh: Hi. A very good morning to all my fellow panelists. Uh, so just a 20 second, uh, spiel for me. I came from academia as an economist. I would say the work was intellectually rewarding but abstract. What pulled me into health, economics and market access was a chance to apply that rigor real world decisions.
Where the analysis or the work I do affects the access to innovative medicine that Biopharma is producing. So that's what attracted me.
Syam Palakurthy: Uh, thank you so much, Amitabh. And Cristina (Cri), will you tell us a little bit about what brought you into this, this landscape, what brought you into this world?
Cristina Masseria: Thank you and nice to be here. And similar to Amitabh, I started in academia where I was for more than 10 years in Europe advising actually many [00:05:00] countries on healthcare reform and how to introduce health technology assessment for assessing medicines. And then similar to Amitabh, I felt that although it was.
Really important work advising policies. I was not really making an impact, a clear impact on the patients and all what the pharma industry and all the innovations that were emerging, and that is where they need to join Pharma. And be involved myself in developing the type of data that beyond the clinical trial, can help us show the value of the medicines, in particularly when we negotiate with budget orders. Because often the data we create from the clinical trials are not sufficient to fully demonstrate the value across the whole population and in different sectors and long term. So, very pleased to be here.
Syam Palakurthy: Awesome. Thank you so much, Cri. [00:06:00] in can you tell us about what was it that brought you to healthcare economics, market access and pharma.
Indranil Bagchi: Yeah, absolutely. Thank you Syam, and good morning. Good afternoon. A real pleasure to be here. Thank you for having me on this podcast on my end. Having grown up in India and having seen the disparities of care across populations and seeing the increasing need for Innovation in the healthcare space and the need to make people live longer and live better lives.
When I was thinking of a career, there was no better option than focusing on market access and working with the large healthcare systems to ensure medicines are accessible to as many patients around the world as possible and making the world a healthier place along the way. So again, really pleased to be here and look forward to the discussion.
Syam Palakurthy: Yeah. That's great to hear. Thank you Indranil. And I think what's, what's interesting to hear from all three of you is just this through line of how do we translate these, these really [00:07:00] interesting sets of ideas into impact for patients. And, and even though you're all coming from fairly different backgrounds and fairly different, uh, parts of the world, that that through line seems pretty clear.
So it's, it's really exciting to. To hear from you on this now.
Syam Palakurthy: Now, one of the other things that we're, we are really excited about is we, we don't spend a lot of time on this podcast talking about the global perspective and how that differs, informs, is informed by the US. And, and given the background that you all have, we're really excited to kind of dive into that and to, to get in there. So, so can you tell us, what, what are the challenges and opportunities, and maybe am, I'll start with you. The challenges and opportunities that you see when it comes to, and particularly this idea of value, for a given treatment. How does that differ when it's in the US versus, the global perspective?
Amitabh Singh: Yeah. Thank you Syam. So let me take a crack. It's a question that deserves, [00:08:00] maybe two, three hours, but I'll try to summarize it in two, three minutes. I think when it comes to definition of value, the fundamental difference between US and the rest of the world, it stems from the difference in the structure of healthcare system as well as the assessment framework, which they use value assessment framework that they use, uh, given the difference in structure of healthcare systems? Uh, think if you look at three things I'll say, if you look at us, uh, it's a fragmented pair system, both horizontally as well as vertically. There are a hundred plus commercial payers. . There's Medicare, there's uh, Medicaid, there's, uh, VA system. Even vertically, if you were to look at, there are more than 60 PBMs, as opposed to that,
in Europe, it is [00:09:00] primarily a single healthcare system, a single payer healthcare system. I think, uh. What is also the second point, what is also important is that there's no universally accepted value framework in the US. Uh, whereas, uh, if you look at the European side, there's an implicit or explicit, uh, effectiveness threshold that determines the value. The third thing I would say, again, it stems from the value assessment framework. There's no universally accepted comparative for value assessment when you're launching a new drug. In US, it's market driven. In Europe, it's mandated by HTAs. So, if I were to summarize it, what I would say is that in the absence of a universal value framework, value is negotiated across different payers in US. In Europe, it is formally assessed, [00:10:00] through a centralized HTA framework. Now, what are the some of the challenges related to that? I think the challenges in demonstrating value, number one, I would say is this whole concept of rebate wall where value it gets obscured by a rebate system. A drug may be of high clinical value, but it may be of low value to the PBM the competitor offers greater rebate.
The second point is related to challenges, is especially in the US it's uh, increasing. Political, what I would say interventions, I think Most Favored Nation is one. Um, IRA is the second one. And on top of it, the access environment itself is getting more and more, challenging. And then I think in US, there's no mechanism for seeking [00:11:00] scientific advice for designing a trial right. That is solely absent in us. That's a huge challenge for us. On the European side, I would say that there's a very narrow definition of value. And clinical benefit, uh uh, it's often driven by hard clinical endpoint and not all dimensions of value get captured. Then on the value erosion side, I think, it's very mechanistic on the European side that IRP actually govern. How, how, your price evolves over time. It is disconnected from demonstration of value over time. So those are some of the challenges that I would highlight. Let me stop here.
Cristina Masseria: Maybe if I can add, I think Amitabh did an amazing overview and as he said, I think we could. Talk about it for hours. And I think you have the three best people to do that. And uh, your [00:12:00] question is actually very relevant because we are in a moment in which value assessment is changing and uh, and there is a lot of uncertainty as well. So there is change and uncertainty, which is not great. Clearly, there is at the moment a big focus on the cost of pharmaceuticals. In the US and globally, and, I think we're all aware of recent policies and promoted by the current administration to introduce reference pricing in the US and to leverage, the other biggest economies, eight biggest economies in the world for reference pricing and, uh. Reference pricing and value assessment are really not similar because when we talk about us, for example, leveraging France Germany as a reference for the pricing, it would mean that the value approach that France is using would be similar to the [00:13:00] value approach the US is. And we know this is very, very different. So something also to emphasize. Amount of resources the US spends on healthcare is very different than the amount of resources France or Germany spends on healthcare versus GDP, because overall, I think the value and the cost, not just pharmaceuticals for. An X-ray or MRI is very different in the US than it is in Germany, France, and Japan.
Right now, when we start saying for pharmaceuticals, we want to use the same level of pricing, but we are not using the same level of pricing for all the other medical intervention or healthcare costs. We are creating some discrepancies and that can actually. Thise investment from pharmaceutical companies. And , [00:14:00] I think we are in a moment in which the US, I think, is still deciding where they should go and what is the best approach. I don't think we are at the arrival line. think we are still running and identifying what is the best approach also for the US to assess value. But I wanted to emphasize reference pricing is not a value assessment tool. Right? And I think it's very important to, to clarify that.
Syam Palakurthy: Yeah, that's a really great point, Cri, because we, we are hearing a lot more about the kinds of reference pricing or using of pricing abroad determined pricing here, but it's not necessarily the same as. As value. Um, and, and there can be some different implications based on how different countries or different cultures value, you know, different parts of the, the healthcare.
Syam Palakurthy: And, and that actually maybe, and Indranil, I'd love to ask this next question to you, I guess is this, um, [00:15:00] question that I think sometimes comes up when people compare the US to outside the us, which is, the way that we treat prevention versus intervention. Can you talk about Indranil, how are biopharmas looking at the difference between, focusing on prevention versus focusing on intervention? Would, would love to hear that in particular, how you think that affects the US as you know, we, we have so much talk right now and over the last really two decades about like, how do we focus on prevention and preventive care more?
Indranil Bagchi: Yeah, absolutely. Thank you for the question, Sam. So what are the implications of prevention versus intervention for biopharma? I would say too often our health systems are focused on reactive treatment. As we all know, we call this a healthcare system, but actually it's more of a sickness care system, not really a system designed to promote health.
So only around 3% of total health [00:16:00] spending is actually dedicated to prevention across all the countries. Meaning people live with diseases that could have been prevented or controlled earlier, and the health systems that must deal with those consequences of not treating those diseases earlier. However, we believe that prevention is the best medicine for patients, societies, health systems and economies.
Investing in prevention delivers better health outcomes is cost effective and healthier people. This is nothing groundbreaking. Elder people are better able to contribute economies and societies at large. So for every $1 invested in improving health, an economic return of between two and $4 is possible.
But for vaccines, it's seven higher, it could be up to $9, and by 2040, health improvements could add 12 trillion to the global GDP. So as we all think about how to help people live healthier lives, there is a clear opportunity to shift from funding sickness systems, as I mentioned before, [00:17:00] to investing in health, enabling earlier action to prevent, diagnose, and treat disease, which would also improve the trajectory of economic growth.
However, this wouldn't happen on its own. Again, as I said. Today, incentives in most healthcare systems around the world, including the US, is geared towards treatment. There needs to be a fundamental shift to encourage more prevention upfront to prevent consumers, patients, to slide down to more costly and more complicated morbidity areas.
Yeah.
Cristina Masseria: If I can add some. So I think as Indranil knows I'm a big fan of prevention and I've worked for many years in vaccines, and I fully agree with what he was saying, one of the harder in doing so is budgeting and often prevention budget and, uh, medicine intervention budget are separate. And so you have also the challenge. Also, [00:18:00] prevention means long-term planning. Often when we think about budgeting for most of the budget holder, we're talking about one or two years budgets. And uh, and you will see the impact of prevention only long term, but in today's society, where we have a huge number of chronic conditions that are actually causing the huge healthcare expenditures for our economies. Prevention is the solution. Because, uh, ma of these chronic condition could be prevented. They are preventable. And even if maybe you cannot avoid them, you can delay the onset and, or the impact of this and something that we need to keep in mind, right? But there are some barriers need to be tackled to make sure that there are the right incentives, as Indranil was saying.
Syam Palakurthy: Yeah. Yeah. I like this. This idea too, of [00:19:00] there're being, there're being actual value in, in ROI for a country to actually invest in the prevention side. I, I'd love to hear, um, Amitabh, maybe if you could talk about, does, does that require a different approach to building a drug to, to identifying the molecule to, to launching the drug that, that focus on prevention.
And if so, how does it change what, what biopharma does need to do, um, to, to really launch more of those preventive drugs.
Amitabh Singh: Thank you Syam. Uh, That's what Indranil was describing and Cri was following up, that's what I was thinking, in terms of what it would take and what is fundamentally different for prevention versus treatment. I think one point I'll make is, when you're talking of prevention, value is harder to prove or establish. Uh, prevention [00:20:00] is, uh, related to benefits that accrue over the longer term. So that's one. The second problem related under the same heading would be that, outcomes are often probabilistic. So it's not determinate, you know, it's probabilistic . You can sometimes try to bridging with surrogate markers, uh, in short term, but that generates uncertainty for the payers that they're not sure whether this will happen, right? fundamentally, value becomes difficult to establish in the short term, and the traditional paradigm of randomized clinical trial does not work anymore. Uh, related to that is know, shift in evidence requirement. So, for example, I would give you two, three examples here. Repatha launched in 2015. But their [00:21:00] outcomes data did not come till 2017. Now, if payers are saying that we will not cover you till the outcomes data comes, then you have lost those two valuable years. Right? if you look at Eliquis, that Aristotle trial came in 2015, the data on reduction in bleeding and stroke came not till 2018. 2019 timeframe. Right? So the question becomes how do we better align with the traditional randomized clinical trial? Or is there a different avenue together to establish the value of prevention? So that's the, you know, fundamental shift. I think if you look at how biopharma adapting, really the bridging link has to be something, has to do [00:22:00] something related to, Either outcome-based, uh, contracting or some warranty or preferential access for preventive therapy. So if you look at Pharma biopharma, they're already experimenting with newer models of value-based, uh, contracting. Also, if you look at pharma, they are now increasingly moving to beyond the pill solutions, right? with, uh, digital healthcare companies or diagnostic companies. That has become a traditional model for, has become embedded in the traditional thinking of biopharma. So those are some of the things that are already happening and. Also, I would say if you think of, uh, not primary prevention, if you think of secondary and tertiary prevention, pharma has invested traditionally, I mean, I would think [00:23:00] of it differently, has invested traditionally in prevention area, right? So for example, if you think of, early neurogenerative diseases. These are all prevention models, right? Uh, you think of Parkinson's, you think of a ALS, you think of ms, you think of Alzheimer's. These are all prevention models, right? You think of cardiometabolic diseases, right? GLP-1 explosion. These are all preventative therapy, right? If you look at oncology interception, these are all preventive models that Biopharma is investing. So it'll take time. I don't think this is, uh, I don't think this can be completely. Uh, can completely move to a paradigm which says that, you know, biopharma is not investing, uh, heavily in prevention.
Yes, they are where the [00:24:00] ROI is and they're not in certain areas where they could do a better job, but fundamentally the structure has to evolve. Structure of RCT structure of how we demonstrate value has to evolve.
Syam Palakurthy: thank you, Amitabh. But I'd love to Cri, turn this next question over to you. It relates to, Amitabh was just saying and what we were saying earlier around the different systems that the US has versus the rest of the world, where potentially it's less determined by national body or by a specific value body, but individual insurance companies. I'm curious. Cri, do you have any thoughts on what needs to change in terms of the incentives given that you have individual insurance companies in the US that are determining that, that value, um, to make it so that it, it makes more sense. And, you know, like, like, I mean, have said there are, there are drugs that, that we have in the market that are preventive focused.
There have been, uh, areas that, that's happening. What [00:25:00] needs to change in terms of the incentives to, to make that, uh, an even bigger focus.
Cristina Masseria: So, as I was saying, we are investing in prevention. Pharma is investing in prevention, and uh, also we know that the budget orders are interested in particular certain, systems more than others. One area I was mentioning before is really the need to look budget differently. So many of the commercial payers, when they do their budgeting decision in really short term, is one year, two years, maximum, three years, as we were saying.
Often for this preventive medicine, you will see the outcome only in the long term. And this horizon might not be sufficient really to demonstrate the value that, you are giving to a patient or to your population by providing these medicines. And this is why Amitabh, I will say one way is to use alternative [00:26:00] approaches with outcome based agreement or value agreement, but they can span across a longer time horizon than potentially the budget that the payers or the insurance companies are holding. this in the past sometimes is creating some. Miscommunications and, but I think we're all working through this and now a lot of the insurance companies, and they have actually value agreement and outcome based agreement as a objective as well. And so they're really moving forward to use more and more this type of.
Tools to demonstrate the value in particular because as Amitabh was saying, for a lot of these inter medications, the clinical trial is short term, often not even from the clinical trial, we can fully demonstrate the long term value and therefore it's very hard even when we have those pricing discussions to align on those [00:27:00] what is the real value for the medicine? And that is when those outcome agreement are very important. And now there is the beauty, there is data everywhere, right? So the insurance companies, they have their own data. They can look at the data the way the pharma companies can look at the data and we can collaborate together, identify what are the right outcomes, what do we wanna measure.
What is the right time horizon for this measurement and adapt our pricing according to the results that we see over time. but as you can imagine, different, these negotiations are happening across a multitude of insurance companies. So it's very complex. While in Europe, let's say you're doing it maybe just with differential authority, once in the US you have to do it many times and uh, and potentially you have different outcomes. With different insurance companies. So you have different models. So you can imagine [00:28:00] the level of complexity. It's, it's quite elevated and what can happen is potentially in one for one insure you are in the formulary for another one, you're not for one, you are preferred. For another one you're not. Right?
So that is why you see also these differences across insurance in, in access and reimbursement of different medication.
Amitabh Singh: So one more thing. Actually let me stop. This is really near and dear to my heart this issue but, but let me, but let me stop and let Indranil comment.
Indranil Bagchi: Uh, not much more to add my, on my end. I mean, I think the miscellaneous incentives we have talked about the need to capture the right data. We have talked about. I think one specific challenge to the US is because of the fragmented healthcare system, you could be going through the process in a certain plan, but when the benefits accrue, you move to a different plan.
So unless there's portability of insurance within the US, that's [00:29:00] the challenge we run into, which we don't run into in a socialized healthcare systems like France that Cristina was describing. Having said that, every healthcare system has its challenges, but if some sort of portability of insurance can be done within the US that would encourage more preventive behavior.
And then the last thing we didn't talk about is a lot of this also behavioral, right? So. Obesity, substance use, et cetera. I mean, these are behavioral notions that cannot be just fixed by medical intervention. These need to be accompanied by behavioral changes, which also needs to be part of the overall regimen along with medical care and everything else.
So yes, the move towards preventive care is happening, but depending on the type of healthcare system, depending on the type of condition we are talking about, the challenges could be different, but nothing that cannot be addressed going forward. Thank you.
Amitabh Singh: So this is, uh, one concrete idea for you, um, this portability mechanism. Right. is something that we [00:30:00] have to work in us, uh, because of membership churn, and that's really, really the most important thing if we need to evolve towards prevention system. The other piece I would say, which is in the same spirit as Indranil said, is, you know, evolution of Benefit design to value-based insurance design. So if something is high value care, there should be low cost sharing, right? For patient US right now, it's exactly the opposite. If it is specialty care. It's very high cost for the patient. So value-based insurance design. That's the second piece that I would say that is, uh, that could happen. The third one is, I would say there has to be a separation between formulary, a formulary, uh, placement and rebate. So this could be done very easily [00:31:00] done by building transparency around, uh, rebate and spread pricing. Right. So that's the third concrete idea for you. And then the fourth one, I would say. There has to be some sort of preferential as I was saying, or coverage for preventive therapy, which is not currently happening. So those are three or four concrete ideas.
Syam Palakurthy: Yeah, I love, I love the concreteness of it. Um, we, we've been talking a lot about the incentives, how we incentivize Biopharmas, insurance companies, even patients, I'd love to hear if we just take a, a step back and, and if you could tell us, maybe Cri, starting with you, like what do you think are the, the biggest access challenges to patients actually for, for the drugs that have actually been launched? Um, or that, that where the molecule has been developed? What do you think the biggest access challenges are? And I'd love to hear your perspective on how it compares in the US versus outside of the [00:32:00] us.
Cristina Masseria: So often is, um, price, I think engineer talked about these, uh, actual discrepancies between value and the share price that the patients are paying where specialty care are extremely expensive in the US and, but they bring huge value to the patients. And, uh, we know that the level inequalities and capability to pay for the patients are very different and, and although pharma companies are often providing vouchers or supporting the patients to cover some of the cost of these medications. They are really substantial cost and they can decentivize the, the patients from continuing from starting the treatment and or [00:33:00] even from continuing the treatment because we, we are really talking about substantial cost and many families in particular. If you, if you're not. Very well off this, this might be very prohibitive. But the second element is also I think, a full understanding of the benefits of the medication. And, uh, and, and I think that is where the dialogue with the with your physicians and now everything is available online. Sometimes it's an advantage, some is a disadvantage because you read so much and you make your own interpretation of things and uh, uh, and we know what we know.
We don't know what we don't know. And, uh, and not often. We don't know what we don't know. And uh, so I always say that for me, uh. the wealth of information that is out there. It's, uh, it's amazing, but [00:34:00] it's, it's also difficult and to digest and that is very important to, to have those very good conversation with your physicians and the experts and to really understand What can be the advantages and disadvantages of this medication in particular where we think about that potentially are taking a variety of medications and there could be side effects or implication of using multiple medications. You really need to understand and know all the potential adverse events and implication that this can have on your body and on your quality of life. And often we don't. The other element that is important in the clinical trial, not often we collect those endpoints that are relevant for the patients. And uh, we are looking at, um, say for a cancer medication, right, the probability of leaving 3, 4, 5, 6 months more. [00:35:00] What if actually those 3, 4, 5, 6 months more, you spend them in a bathroom? Because you're showing up, right? So. That is not good for the patient. So clearly the patient doesn't have an incentive in taking the medication, but not often, or now we're doing more and more, and even FDA's investing on this. There is a huge now framework to push forward to really collect those endpoints that are relevant to the patients in terms of their quality of life, but also their experience. And, uh, with, uh, the healthcare system and the impact, the disease on their daily life daily routine capability to work to bring their kids to school or to the park. Because this has a huge impact on the probability of taking those medications.
Syam Palakurthy: Yeah, that makes a lot of sense. Thank you.
Syam Palakurthy: And I [00:36:00] want to ask this because it's so, uh, it's so topical right now. We're seeing artificial intelligence being implied to. Lot of different areas at the moment. Uh, maybe Indranil I'll ask you this question, do you have any thoughts on, and, and I'd love to hear from Amitabh and Cri and as well, do you have any thoughts on where can artificial intelligence have an impact on the, you know, the value, access and pricing side and where, where do you think it's just not going to make that much of a difference?
Indranil Bagchi: Thank you, Syam, for the question. Of course, I mean, artificial intelligence is the next big thing that we are all looking for the proof to happen. And, uh, I, I know it's being applied in many different areas. I think the application to healthcare may have been somewhat slower than some of the other industry that we are familiar with.
When it comes to access, where can it help the most? It can help with predictability in the end, drug development and access to medicines. The biggest piece that gets [00:37:00] along the way is uncertainty of science, and that's where AI can step in. And just by simply looking at previous results that have been obtained and digging into those databases and help us plan better clinical trials, making sure the right population is included, making sure the right endpoints are included, and if we do all of that,
what could be the predictability of the results clinically humanistically, economically, and driven by that, what could be the corresponding access. So I think that's where industry as well as the different stakeholders are trying to apply artificial intelligence. And by applying it successfully, if we can take some of the time lag out, so reduce the time to drug development.
As well as take some of the cost out, reduce the cost of drug development, that could be a significant contribution to human society. So I would say yes, if you have to focus on one area, that would be removing uncertainty. And the way we are doing pilots in terms of how we're applying AI is [00:38:00] as we have to respond to the different, you know, assessment agencies, health technology, assessment agencies.
It's just using AI to be able to respond quickly just in time, and thereby reducing the need to engage in meetings and thereby reducing the need to wait and improving time to access to medicines. Yeah.
Amitabh Singh: So two or three points here, uh, in addition to, I think Indranil alluded to use of technology to enhance the. Uh, RCPs, uh, randomized clinical trial. One way we should think about, uh, AI is that it has dramatically reduced the cost of doing, uh, real world evidence, collecting real world evidence data, right? So obviously, what are some of the ways in which real world evidence can be scaled up with the help of ai? not an expert in ai, but that's, uh, one of the opportunity. I [00:39:00] think the second piece where AI can help us is in what I would say, identification of subpopulations, uh, where the patient is more likely to, uh, respond to a particular treatment.
Right. Uh. That actually feeds into how you can better design your clinical studies to demonstrate value, right? if you can identify those subpopulation and if you can recruit based on that, uh. Avoiding the bias that is inherent in that kind of design. If you can do that, that is, uh, really important. And the third piece I would say, and this is getting into the technical, uh, aspects, but AI has, uh, enabled us to now, um, and NICE is using it, uh, [00:40:00] is called dynamic economic model. So your cost effectiveness, uh. Models are continuously updated in real time, on a real time basis. So those are two or three ideas that comes to mind off the top of my head.
The final piece I would say is that can we deploy AI to identify where value-based contracting has worked well in the past, and then learn from that and apply that both in the payer and healthcare system setting as well as for biopharma.
Syam Palakurthy: Great. Thank you. And crew. Any anything you'd want to add to that?
Cristina Masseria: I think Indranil and Amitabh covered most of it. And as Amitabh said, where it's just the beginning. I think for me, 2025 was the boom and uh, everything now is in front of. Us [00:41:00] in 2026 will be the moment where actually we're going to see some of the results also in healthcare. And, uh, because some of those applications now are becoming real and we see the real impact. I think this will be, will be a year, I suppose, full of, um, of those results of using AI and gaining more efficiencies and more predictability as Indranil mentioned, which is key for budgeting.
Syam Palakurthy: Yeah, that makes sense. And, and I know we're, we're gonna have to start wrapping, uh, the conversation. As you might know, we, we have listeners who come from the provider side, from the biopharma side, the payer side, and even some of the, the policy making and regulatory side. love for, for each of you and maybe starting with Amitabh and then Cri and then Indranil. If you just have one piece of advice or one recommendation, and you can, you can direct it to any of those four stakeholders, the provider, biopharma, [00:42:00] uh, the payer or the regulatory side. What, what one piece of advice or ask would you make, um, to, to one of those groups to kind of move this forward so more patients are able to get on the right treatment at the, the right moment in time.
Amitabh Singh: Yeah. Wow. That's a big question. Uh, Sam, uh. I think off the top of my head, what comes to my mind is. This whole concept of fragmentation on the payer side, right? Uh, especially in the US healthcare system. And, uh, we in biopharma are often, um. Complaining that it's too fragmented, too challenging, and it's, it's, it's not possible and it is beyond [00:43:00] repair.
I think what my advice to, you know, leaders like, uh, Cri and uh, and Biopharma is, uh, would be that, you know. Market access in 2026 is no longer about winning every negotiation with PBM. It is about, uh, what I would say managing the trade-offs, right? If PBM says No, put patients to cash. GLP one have demonstrated that employer says, uh, something is too expensive, offer them outcomes based contract. government says, uh, well, it's too high, then manufacturers can accept, uh, MFP in return for. Larger volume. that's what I, I think, I think we [00:44:00] should focus more on what are the tradeoffs and what is feasible within the context of those tradeoffs. Rather than complain about healthcare system and its fragmentation.
Syam Palakurthy: Yeah. I, I love that it's very realistic and, uh, realism driven, but very actionable. Cree, how about you?
Cristina Masseria: So I would, um, ask them to talk more among each other’s and, uh, because at the end of the day, we all share the same objective, which is improving the health of the society. And making sure the right patients gets the right medicine at the right time. Because all of us, wherever we sit, we are patients and or we have patients in our families, right?
So I feel we need to improve the level of trust and collaboration and dialogue. [00:45:00] if we are able to do that, I feel that a lot of those misincentives and fragmentation. Can be resolved. And that is going back to Amitabh, right? We can find a different way of doing things, but we can only do that if we have a very honest and open dialogue where we are listening to each other's needs and we try to find productive and efficient solutions together.
Syam Palakurthy: Yeah.
Indranil Bagchi: And not much more to add on my end, I think we started the conversation with fragmentation of the healthcare system. I would end the conversation and the exact opposite place, which is how can we get to a holistic approach to healthcare? And I think that's what both Cristina and Amitabh alluded to.
Uh, every different stakeholder has a different role to play. They have different needs, they have different skills and capabilities. Which requires us to engage in dialogue, which Cristina has already referred to. [00:46:00] It also requires us to put each other in other shoes and try to understand where they're coming from and what they're bringing to the table.
But in the end, if we can have a more holistic approach to healthcare, make prevention along with treatment, a part of the whole cycle, and in the end, making sure in whether it's. A long-term view, whether it's view across different segments, we have the ultimate patient benefit in mind and drive towards that.
I'm confident we can improve access to medicines and thereby make the world a better place. So putting a plug for holistic healthcare. And thank you for inviting us to this podcast.
Syam Palakurthy: Yeah. Well that, that seems like a really wonderful note to end on. Thank you all for taking the time. I know you're in different time zones, different parts of the world. Uh, so we're, we're thrilled that we could get the three of you in your brains in one place, in one conversation together.
Kip Theno: Yes. Thank you all. And I always end with an Easter egg question, by the way, Sean, thank you for [00:47:00] as usual, masterful. Um, look, we spend 17% of our GDP here and I don't think we're going to solve this overnight 'cause the trouble certainly didn't happen. 24 hours ago, but we'd love to have you back on to talk about access cost prevention, the great debate on PBMs, which is pretty hot topic here right now.
Payer uniformity. So here's my Easter egg question, and again, thank you all for your time. I dunno if you saw the big news, but steak has just been put back at the top of the pyramid in uh, in our dietary plans. I don’t know if you saw that it was moved back to the top and I've got three doctors on up or thumbs down.
I'm personally very pleased with that decision.
Amitabh Singh: How can I put a thumbs down for steaks?
Kip Theno: one, uh, that's a sideways, uh, that's a thumbs down. All right. I ate the final vote. Two to one. Two to two. We tied. Okay. Thank you guys. Hey, again, happy New Year. Appreciate y'all being on the show. Um, 2026 off to a great [00:48:00] start on the Road to Care podcast and, and again, together we can make things right.
Look forward to seeing you again this year. Thank you all.
Indranil Bagchi: Thank you very much.
Cristina Masseria: you.
Amitabh Singh: Thank you.
Syam Palakurthy: Thank you all.
Thank you for joining the Road to Care podcast, hosted by SamaCare, the leader in prior authorization technology and services, where through a script to therapy operating system, we enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced, and recorded by Jamestown.
Podcast produced by JFACTOR, visit https://www.jfactor.com/
Together, we can make healthcare right. Here are some of the outstanding healthcare organizations and associations championing patient health mentioned in this episode:
[00:00:00]
Welcome to the Road to Care podcast hosted by SamaCare, where we'll talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today. And where we see it evolving some care's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together we can simply make things right.
Kip Theno: Okay, welcome back to The Road to Care podcast everybody and happy 2026. I can't believe it's here. As you can see, we've got a brand new studio. We've got fancy headphones we've splurged for, uh, and, uh, we're looking forward to a great show. We've got a panel of three doctors today and our CEO, Syam Palakurthy.
Our panel Dr. Amitabh Singh, Dr. Indranil Bagchi, and Dr. Cristina Masseria. Dr. Singh is a highly experienced and accomplished leader in [00:01:00] market access, health, economics, and real-world evidence generation.
With nearly 30 years of experience in major pharmaceutical companies such as AbbVie, Wyeth, Pfizer, and Novartis, Dr. Singh is passionate about building scalable and groundbreaking capabilities to enhance value, differentiation, and demonstration. And a proven track record of leading successful teams in areas such as value and access, pricing and reimbursement, and evidence generation.
Dr. Singh has an M. Phil. in international trade and econometrics, and a PhD in economics. Dr. Singh retired two years ago in his final position, he held the role of Worldwide Head and vice president of HEOR, in Novartis oncology.
Dr. Bagchi currently serves as global head of pricing and market access at GSK, where he drives overall strategy on value demonstration, and market access across all product areas.
In the GSK portfolio, Dr. Bagchi has extensive experience and proven track record of leading value and access pricing, [00:02:00] reimbursement, and health outcomes functions in major companies, including GlaxoSmithKline, Wyeth, Pfizer. Novartis, Dr. Bagchi has an MS in healthcare administration and a PhD in pharmaceutical socioeconomics.
Dr. Masseria currently serves as vice president of value and access for AESARA, a digital forward market access agency. Prior to that, Dr. Masseria served as vice president patient health and impact hospital and vaccine business units at Pfizer and worked in health outcome vaccines. At GSK. Dr. Masseria began her career in academia.
As a health economics researcher and lecturer at the London School of Economics and Political Science LSC. Dr. Masseria has an MSC in health economics and a PhD in economics.
I do want to take a quick minute to thank Jillian Kushner (jfactor.com), our program director, all our listeners. Our viewers and subscribers and of [00:03:00] course our guests in 2025 making R2C Road to Care podcast, one of the top healthcare podcasts in the country. Um, and as we do, sometimes I will not just be the host with the microphone.
I'm going to pass that golden mic, the torch, over to Syam Palakurthy, our CEO of SamaCare to start with the intros and have a robust discussion. So welcome back everybody.
Syam Palakurthy: Great. Well, thank you Kip and thank you everyone for listening. We are super, super excited about this conversation today. We have not just a panel which is new for us, but also a panel of absolute global pharma All Stars. They have seen so much, across so many different regulatory landscapes and so many different, drug launches. So real excited for this. Maybe I, will start with having, each of the three of you just tell us a little bit about your background. What drew you to healthcare in the first place and, and to health economics and into market access. Amitabh, let's start with [00:04:00] you.
Amitabh Singh: Hi. A very good morning to all my fellow panelists. Uh, so just a 20 second, uh, spiel for me. I came from academia as an economist. I would say the work was intellectually rewarding but abstract. What pulled me into health, economics and market access was a chance to apply that rigor real world decisions.
Where the analysis or the work I do affects the access to innovative medicine that Biopharma is producing. So that's what attracted me.
Syam Palakurthy: Uh, thank you so much, Amitabh. And Cristina (Cri), will you tell us a little bit about what brought you into this, this landscape, what brought you into this world?
Cristina Masseria: Thank you and nice to be here. And similar to Amitabh, I started in academia where I was for more than 10 years in Europe advising actually many [00:05:00] countries on healthcare reform and how to introduce health technology assessment for assessing medicines. And then similar to Amitabh, I felt that although it was.
Really important work advising policies. I was not really making an impact, a clear impact on the patients and all what the pharma industry and all the innovations that were emerging, and that is where they need to join Pharma. And be involved myself in developing the type of data that beyond the clinical trial, can help us show the value of the medicines, in particularly when we negotiate with budget orders. Because often the data we create from the clinical trials are not sufficient to fully demonstrate the value across the whole population and in different sectors and long term. So, very pleased to be here.
Syam Palakurthy: Awesome. Thank you so much, Cri. [00:06:00] in can you tell us about what was it that brought you to healthcare economics, market access and pharma.
Indranil Bagchi: Yeah, absolutely. Thank you Syam, and good morning. Good afternoon. A real pleasure to be here. Thank you for having me on this podcast on my end. Having grown up in India and having seen the disparities of care across populations and seeing the increasing need for Innovation in the healthcare space and the need to make people live longer and live better lives.
When I was thinking of a career, there was no better option than focusing on market access and working with the large healthcare systems to ensure medicines are accessible to as many patients around the world as possible and making the world a healthier place along the way. So again, really pleased to be here and look forward to the discussion.
Syam Palakurthy: Yeah. That's great to hear. Thank you Indranil. And I think what's, what's interesting to hear from all three of you is just this through line of how do we translate these, these really [00:07:00] interesting sets of ideas into impact for patients. And, and even though you're all coming from fairly different backgrounds and fairly different, uh, parts of the world, that that through line seems pretty clear.
So it's, it's really exciting to. To hear from you on this now.
Syam Palakurthy: Now, one of the other things that we're, we are really excited about is we, we don't spend a lot of time on this podcast talking about the global perspective and how that differs, informs, is informed by the US. And, and given the background that you all have, we're really excited to kind of dive into that and to, to get in there. So, so can you tell us, what, what are the challenges and opportunities, and maybe am, I'll start with you. The challenges and opportunities that you see when it comes to, and particularly this idea of value, for a given treatment. How does that differ when it's in the US versus, the global perspective?
Amitabh Singh: Yeah. Thank you Syam. So let me take a crack. It's a question that deserves, [00:08:00] maybe two, three hours, but I'll try to summarize it in two, three minutes. I think when it comes to definition of value, the fundamental difference between US and the rest of the world, it stems from the difference in the structure of healthcare system as well as the assessment framework, which they use value assessment framework that they use, uh, given the difference in structure of healthcare systems? Uh, think if you look at three things I'll say, if you look at us, uh, it's a fragmented pair system, both horizontally as well as vertically. There are a hundred plus commercial payers. . There's Medicare, there's uh, Medicaid, there's, uh, VA system. Even vertically, if you were to look at, there are more than 60 PBMs, as opposed to that,
in Europe, it is [00:09:00] primarily a single healthcare system, a single payer healthcare system. I think, uh. What is also the second point, what is also important is that there's no universally accepted value framework in the US. Uh, whereas, uh, if you look at the European side, there's an implicit or explicit, uh, effectiveness threshold that determines the value. The third thing I would say, again, it stems from the value assessment framework. There's no universally accepted comparative for value assessment when you're launching a new drug. In US, it's market driven. In Europe, it's mandated by HTAs. So, if I were to summarize it, what I would say is that in the absence of a universal value framework, value is negotiated across different payers in US. In Europe, it is formally assessed, [00:10:00] through a centralized HTA framework. Now, what are the some of the challenges related to that? I think the challenges in demonstrating value, number one, I would say is this whole concept of rebate wall where value it gets obscured by a rebate system. A drug may be of high clinical value, but it may be of low value to the PBM the competitor offers greater rebate.
The second point is related to challenges, is especially in the US it's uh, increasing. Political, what I would say interventions, I think Most Favored Nation is one. Um, IRA is the second one. And on top of it, the access environment itself is getting more and more, challenging. And then I think in US, there's no mechanism for seeking [00:11:00] scientific advice for designing a trial right. That is solely absent in us. That's a huge challenge for us. On the European side, I would say that there's a very narrow definition of value. And clinical benefit, uh uh, it's often driven by hard clinical endpoint and not all dimensions of value get captured. Then on the value erosion side, I think, it's very mechanistic on the European side that IRP actually govern. How, how, your price evolves over time. It is disconnected from demonstration of value over time. So those are some of the challenges that I would highlight. Let me stop here.
Cristina Masseria: Maybe if I can add, I think Amitabh did an amazing overview and as he said, I think we could. Talk about it for hours. And I think you have the three best people to do that. And uh, your [00:12:00] question is actually very relevant because we are in a moment in which value assessment is changing and uh, and there is a lot of uncertainty as well. So there is change and uncertainty, which is not great. Clearly, there is at the moment a big focus on the cost of pharmaceuticals. In the US and globally, and, I think we're all aware of recent policies and promoted by the current administration to introduce reference pricing in the US and to leverage, the other biggest economies, eight biggest economies in the world for reference pricing and, uh. Reference pricing and value assessment are really not similar because when we talk about us, for example, leveraging France Germany as a reference for the pricing, it would mean that the value approach that France is using would be similar to the [00:13:00] value approach the US is. And we know this is very, very different. So something also to emphasize. Amount of resources the US spends on healthcare is very different than the amount of resources France or Germany spends on healthcare versus GDP, because overall, I think the value and the cost, not just pharmaceuticals for. An X-ray or MRI is very different in the US than it is in Germany, France, and Japan.
Right now, when we start saying for pharmaceuticals, we want to use the same level of pricing, but we are not using the same level of pricing for all the other medical intervention or healthcare costs. We are creating some discrepancies and that can actually. Thise investment from pharmaceutical companies. And , [00:14:00] I think we are in a moment in which the US, I think, is still deciding where they should go and what is the best approach. I don't think we are at the arrival line. think we are still running and identifying what is the best approach also for the US to assess value. But I wanted to emphasize reference pricing is not a value assessment tool. Right? And I think it's very important to, to clarify that.
Syam Palakurthy: Yeah, that's a really great point, Cri, because we, we are hearing a lot more about the kinds of reference pricing or using of pricing abroad determined pricing here, but it's not necessarily the same as. As value. Um, and, and there can be some different implications based on how different countries or different cultures value, you know, different parts of the, the healthcare.
Syam Palakurthy: And, and that actually maybe, and Indranil, I'd love to ask this next question to you, I guess is this, um, [00:15:00] question that I think sometimes comes up when people compare the US to outside the us, which is, the way that we treat prevention versus intervention. Can you talk about Indranil, how are biopharmas looking at the difference between, focusing on prevention versus focusing on intervention? Would, would love to hear that in particular, how you think that affects the US as you know, we, we have so much talk right now and over the last really two decades about like, how do we focus on prevention and preventive care more?
Indranil Bagchi: Yeah, absolutely. Thank you for the question, Sam. So what are the implications of prevention versus intervention for biopharma? I would say too often our health systems are focused on reactive treatment. As we all know, we call this a healthcare system, but actually it's more of a sickness care system, not really a system designed to promote health.
So only around 3% of total health [00:16:00] spending is actually dedicated to prevention across all the countries. Meaning people live with diseases that could have been prevented or controlled earlier, and the health systems that must deal with those consequences of not treating those diseases earlier. However, we believe that prevention is the best medicine for patients, societies, health systems and economies.
Investing in prevention delivers better health outcomes is cost effective and healthier people. This is nothing groundbreaking. Elder people are better able to contribute economies and societies at large. So for every $1 invested in improving health, an economic return of between two and $4 is possible.
But for vaccines, it's seven higher, it could be up to $9, and by 2040, health improvements could add 12 trillion to the global GDP. So as we all think about how to help people live healthier lives, there is a clear opportunity to shift from funding sickness systems, as I mentioned before, [00:17:00] to investing in health, enabling earlier action to prevent, diagnose, and treat disease, which would also improve the trajectory of economic growth.
However, this wouldn't happen on its own. Again, as I said. Today, incentives in most healthcare systems around the world, including the US, is geared towards treatment. There needs to be a fundamental shift to encourage more prevention upfront to prevent consumers, patients, to slide down to more costly and more complicated morbidity areas.
Yeah.
Cristina Masseria: If I can add some. So I think as Indranil knows I'm a big fan of prevention and I've worked for many years in vaccines, and I fully agree with what he was saying, one of the harder in doing so is budgeting and often prevention budget and, uh, medicine intervention budget are separate. And so you have also the challenge. Also, [00:18:00] prevention means long-term planning. Often when we think about budgeting for most of the budget holder, we're talking about one or two years budgets. And uh, and you will see the impact of prevention only long term, but in today's society, where we have a huge number of chronic conditions that are actually causing the huge healthcare expenditures for our economies. Prevention is the solution. Because, uh, ma of these chronic condition could be prevented. They are preventable. And even if maybe you cannot avoid them, you can delay the onset and, or the impact of this and something that we need to keep in mind, right? But there are some barriers need to be tackled to make sure that there are the right incentives, as Indranil was saying.
Syam Palakurthy: Yeah. Yeah. I like this. This idea too, of [00:19:00] there're being, there're being actual value in, in ROI for a country to actually invest in the prevention side. I, I'd love to hear, um, Amitabh, maybe if you could talk about, does, does that require a different approach to building a drug to, to identifying the molecule to, to launching the drug that, that focus on prevention.
And if so, how does it change what, what biopharma does need to do, um, to, to really launch more of those preventive drugs.
Amitabh Singh: Thank you Syam. Uh, That's what Indranil was describing and Cri was following up, that's what I was thinking, in terms of what it would take and what is fundamentally different for prevention versus treatment. I think one point I'll make is, when you're talking of prevention, value is harder to prove or establish. Uh, prevention [00:20:00] is, uh, related to benefits that accrue over the longer term. So that's one. The second problem related under the same heading would be that, outcomes are often probabilistic. So it's not determinate, you know, it's probabilistic . You can sometimes try to bridging with surrogate markers, uh, in short term, but that generates uncertainty for the payers that they're not sure whether this will happen, right? fundamentally, value becomes difficult to establish in the short term, and the traditional paradigm of randomized clinical trial does not work anymore. Uh, related to that is know, shift in evidence requirement. So, for example, I would give you two, three examples here. Repatha launched in 2015. But their [00:21:00] outcomes data did not come till 2017. Now, if payers are saying that we will not cover you till the outcomes data comes, then you have lost those two valuable years. Right? if you look at Eliquis, that Aristotle trial came in 2015, the data on reduction in bleeding and stroke came not till 2018. 2019 timeframe. Right? So the question becomes how do we better align with the traditional randomized clinical trial? Or is there a different avenue together to establish the value of prevention? So that's the, you know, fundamental shift. I think if you look at how biopharma adapting, really the bridging link has to be something, has to do [00:22:00] something related to, Either outcome-based, uh, contracting or some warranty or preferential access for preventive therapy. So if you look at Pharma biopharma, they're already experimenting with newer models of value-based, uh, contracting. Also, if you look at pharma, they are now increasingly moving to beyond the pill solutions, right? with, uh, digital healthcare companies or diagnostic companies. That has become a traditional model for, has become embedded in the traditional thinking of biopharma. So those are some of the things that are already happening and. Also, I would say if you think of, uh, not primary prevention, if you think of secondary and tertiary prevention, pharma has invested traditionally, I mean, I would think [00:23:00] of it differently, has invested traditionally in prevention area, right? So for example, if you think of, early neurogenerative diseases. These are all prevention models, right? Uh, you think of Parkinson's, you think of a ALS, you think of ms, you think of Alzheimer's. These are all prevention models, right? You think of cardiometabolic diseases, right? GLP-1 explosion. These are all preventative therapy, right? If you look at oncology interception, these are all preventive models that Biopharma is investing. So it'll take time. I don't think this is, uh, I don't think this can be completely. Uh, can completely move to a paradigm which says that, you know, biopharma is not investing, uh, heavily in prevention.
Yes, they are where the [00:24:00] ROI is and they're not in certain areas where they could do a better job, but fundamentally the structure has to evolve. Structure of RCT structure of how we demonstrate value has to evolve.
Syam Palakurthy: thank you, Amitabh. But I'd love to Cri, turn this next question over to you. It relates to, Amitabh was just saying and what we were saying earlier around the different systems that the US has versus the rest of the world, where potentially it's less determined by national body or by a specific value body, but individual insurance companies. I'm curious. Cri, do you have any thoughts on what needs to change in terms of the incentives given that you have individual insurance companies in the US that are determining that, that value, um, to make it so that it, it makes more sense. And, you know, like, like, I mean, have said there are, there are drugs that, that we have in the market that are preventive focused.
There have been, uh, areas that, that's happening. What [00:25:00] needs to change in terms of the incentives to, to make that, uh, an even bigger focus.
Cristina Masseria: So, as I was saying, we are investing in prevention. Pharma is investing in prevention, and uh, also we know that the budget orders are interested in particular certain, systems more than others. One area I was mentioning before is really the need to look budget differently. So many of the commercial payers, when they do their budgeting decision in really short term, is one year, two years, maximum, three years, as we were saying.
Often for this preventive medicine, you will see the outcome only in the long term. And this horizon might not be sufficient really to demonstrate the value that, you are giving to a patient or to your population by providing these medicines. And this is why Amitabh, I will say one way is to use alternative [00:26:00] approaches with outcome based agreement or value agreement, but they can span across a longer time horizon than potentially the budget that the payers or the insurance companies are holding. this in the past sometimes is creating some. Miscommunications and, but I think we're all working through this and now a lot of the insurance companies, and they have actually value agreement and outcome based agreement as a objective as well. And so they're really moving forward to use more and more this type of.
Tools to demonstrate the value in particular because as Amitabh was saying, for a lot of these inter medications, the clinical trial is short term, often not even from the clinical trial, we can fully demonstrate the long term value and therefore it's very hard even when we have those pricing discussions to align on those [00:27:00] what is the real value for the medicine? And that is when those outcome agreement are very important. And now there is the beauty, there is data everywhere, right? So the insurance companies, they have their own data. They can look at the data the way the pharma companies can look at the data and we can collaborate together, identify what are the right outcomes, what do we wanna measure.
What is the right time horizon for this measurement and adapt our pricing according to the results that we see over time. but as you can imagine, different, these negotiations are happening across a multitude of insurance companies. So it's very complex. While in Europe, let's say you're doing it maybe just with differential authority, once in the US you have to do it many times and uh, and potentially you have different outcomes. With different insurance companies. So you have different models. So you can imagine [00:28:00] the level of complexity. It's, it's quite elevated and what can happen is potentially in one for one insure you are in the formulary for another one, you're not for one, you are preferred. For another one you're not. Right?
So that is why you see also these differences across insurance in, in access and reimbursement of different medication.
Amitabh Singh: So one more thing. Actually let me stop. This is really near and dear to my heart this issue but, but let me, but let me stop and let Indranil comment.
Indranil Bagchi: Uh, not much more to add my, on my end. I mean, I think the miscellaneous incentives we have talked about the need to capture the right data. We have talked about. I think one specific challenge to the US is because of the fragmented healthcare system, you could be going through the process in a certain plan, but when the benefits accrue, you move to a different plan.
So unless there's portability of insurance within the US, that's [00:29:00] the challenge we run into, which we don't run into in a socialized healthcare systems like France that Cristina was describing. Having said that, every healthcare system has its challenges, but if some sort of portability of insurance can be done within the US that would encourage more preventive behavior.
And then the last thing we didn't talk about is a lot of this also behavioral, right? So. Obesity, substance use, et cetera. I mean, these are behavioral notions that cannot be just fixed by medical intervention. These need to be accompanied by behavioral changes, which also needs to be part of the overall regimen along with medical care and everything else.
So yes, the move towards preventive care is happening, but depending on the type of healthcare system, depending on the type of condition we are talking about, the challenges could be different, but nothing that cannot be addressed going forward. Thank you.
Amitabh Singh: So this is, uh, one concrete idea for you, um, this portability mechanism. Right. is something that we [00:30:00] have to work in us, uh, because of membership churn, and that's really, really the most important thing if we need to evolve towards prevention system. The other piece I would say, which is in the same spirit as Indranil said, is, you know, evolution of Benefit design to value-based insurance design. So if something is high value care, there should be low cost sharing, right? For patient US right now, it's exactly the opposite. If it is specialty care. It's very high cost for the patient. So value-based insurance design. That's the second piece that I would say that is, uh, that could happen. The third one is, I would say there has to be a separation between formulary, a formulary, uh, placement and rebate. So this could be done very easily [00:31:00] done by building transparency around, uh, rebate and spread pricing. Right. So that's the third concrete idea for you. And then the fourth one, I would say. There has to be some sort of preferential as I was saying, or coverage for preventive therapy, which is not currently happening. So those are three or four concrete ideas.
Syam Palakurthy: Yeah, I love, I love the concreteness of it. Um, we, we've been talking a lot about the incentives, how we incentivize Biopharmas, insurance companies, even patients, I'd love to hear if we just take a, a step back and, and if you could tell us, maybe Cri, starting with you, like what do you think are the, the biggest access challenges to patients actually for, for the drugs that have actually been launched? Um, or that, that where the molecule has been developed? What do you think the biggest access challenges are? And I'd love to hear your perspective on how it compares in the US versus outside of the [00:32:00] us.
Cristina Masseria: So often is, um, price, I think engineer talked about these, uh, actual discrepancies between value and the share price that the patients are paying where specialty care are extremely expensive in the US and, but they bring huge value to the patients. And, uh, we know that the level inequalities and capability to pay for the patients are very different and, and although pharma companies are often providing vouchers or supporting the patients to cover some of the cost of these medications. They are really substantial cost and they can decentivize the, the patients from continuing from starting the treatment and or [00:33:00] even from continuing the treatment because we, we are really talking about substantial cost and many families in particular. If you, if you're not. Very well off this, this might be very prohibitive. But the second element is also I think, a full understanding of the benefits of the medication. And, uh, and, and I think that is where the dialogue with the with your physicians and now everything is available online. Sometimes it's an advantage, some is a disadvantage because you read so much and you make your own interpretation of things and uh, uh, and we know what we know.
We don't know what we don't know. And, uh, and not often. We don't know what we don't know. And uh, so I always say that for me, uh. the wealth of information that is out there. It's, uh, it's amazing, but [00:34:00] it's, it's also difficult and to digest and that is very important to, to have those very good conversation with your physicians and the experts and to really understand What can be the advantages and disadvantages of this medication in particular where we think about that potentially are taking a variety of medications and there could be side effects or implication of using multiple medications. You really need to understand and know all the potential adverse events and implication that this can have on your body and on your quality of life. And often we don't. The other element that is important in the clinical trial, not often we collect those endpoints that are relevant for the patients. And uh, we are looking at, um, say for a cancer medication, right, the probability of leaving 3, 4, 5, 6 months more. [00:35:00] What if actually those 3, 4, 5, 6 months more, you spend them in a bathroom? Because you're showing up, right? So. That is not good for the patient. So clearly the patient doesn't have an incentive in taking the medication, but not often, or now we're doing more and more, and even FDA's investing on this. There is a huge now framework to push forward to really collect those endpoints that are relevant to the patients in terms of their quality of life, but also their experience. And, uh, with, uh, the healthcare system and the impact, the disease on their daily life daily routine capability to work to bring their kids to school or to the park. Because this has a huge impact on the probability of taking those medications.
Syam Palakurthy: Yeah, that makes a lot of sense. Thank you.
Syam Palakurthy: And I [00:36:00] want to ask this because it's so, uh, it's so topical right now. We're seeing artificial intelligence being implied to. Lot of different areas at the moment. Uh, maybe Indranil I'll ask you this question, do you have any thoughts on, and, and I'd love to hear from Amitabh and Cri and as well, do you have any thoughts on where can artificial intelligence have an impact on the, you know, the value, access and pricing side and where, where do you think it's just not going to make that much of a difference?
Indranil Bagchi: Thank you, Syam, for the question. Of course, I mean, artificial intelligence is the next big thing that we are all looking for the proof to happen. And, uh, I, I know it's being applied in many different areas. I think the application to healthcare may have been somewhat slower than some of the other industry that we are familiar with.
When it comes to access, where can it help the most? It can help with predictability in the end, drug development and access to medicines. The biggest piece that gets [00:37:00] along the way is uncertainty of science, and that's where AI can step in. And just by simply looking at previous results that have been obtained and digging into those databases and help us plan better clinical trials, making sure the right population is included, making sure the right endpoints are included, and if we do all of that,
what could be the predictability of the results clinically humanistically, economically, and driven by that, what could be the corresponding access. So I think that's where industry as well as the different stakeholders are trying to apply artificial intelligence. And by applying it successfully, if we can take some of the time lag out, so reduce the time to drug development.
As well as take some of the cost out, reduce the cost of drug development, that could be a significant contribution to human society. So I would say yes, if you have to focus on one area, that would be removing uncertainty. And the way we are doing pilots in terms of how we're applying AI is [00:38:00] as we have to respond to the different, you know, assessment agencies, health technology, assessment agencies.
It's just using AI to be able to respond quickly just in time, and thereby reducing the need to engage in meetings and thereby reducing the need to wait and improving time to access to medicines. Yeah.
Amitabh Singh: So two or three points here, uh, in addition to, I think Indranil alluded to use of technology to enhance the. Uh, RCPs, uh, randomized clinical trial. One way we should think about, uh, AI is that it has dramatically reduced the cost of doing, uh, real world evidence, collecting real world evidence data, right? So obviously, what are some of the ways in which real world evidence can be scaled up with the help of ai? not an expert in ai, but that's, uh, one of the opportunity. I [00:39:00] think the second piece where AI can help us is in what I would say, identification of subpopulations, uh, where the patient is more likely to, uh, respond to a particular treatment.
Right. Uh. That actually feeds into how you can better design your clinical studies to demonstrate value, right? if you can identify those subpopulation and if you can recruit based on that, uh. Avoiding the bias that is inherent in that kind of design. If you can do that, that is, uh, really important. And the third piece I would say, and this is getting into the technical, uh, aspects, but AI has, uh, enabled us to now, um, and NICE is using it, uh, [00:40:00] is called dynamic economic model. So your cost effectiveness, uh. Models are continuously updated in real time, on a real time basis. So those are two or three ideas that comes to mind off the top of my head.
The final piece I would say is that can we deploy AI to identify where value-based contracting has worked well in the past, and then learn from that and apply that both in the payer and healthcare system setting as well as for biopharma.
Syam Palakurthy: Great. Thank you. And crew. Any anything you'd want to add to that?
Cristina Masseria: I think Indranil and Amitabh covered most of it. And as Amitabh said, where it's just the beginning. I think for me, 2025 was the boom and uh, everything now is in front of. Us [00:41:00] in 2026 will be the moment where actually we're going to see some of the results also in healthcare. And, uh, because some of those applications now are becoming real and we see the real impact. I think this will be, will be a year, I suppose, full of, um, of those results of using AI and gaining more efficiencies and more predictability as Indranil mentioned, which is key for budgeting.
Syam Palakurthy: Yeah, that makes sense. And, and I know we're, we're gonna have to start wrapping, uh, the conversation. As you might know, we, we have listeners who come from the provider side, from the biopharma side, the payer side, and even some of the, the policy making and regulatory side. love for, for each of you and maybe starting with Amitabh and then Cri and then Indranil. If you just have one piece of advice or one recommendation, and you can, you can direct it to any of those four stakeholders, the provider, biopharma, [00:42:00] uh, the payer or the regulatory side. What, what one piece of advice or ask would you make, um, to, to one of those groups to kind of move this forward so more patients are able to get on the right treatment at the, the right moment in time.
Amitabh Singh: Yeah. Wow. That's a big question. Uh, Sam, uh. I think off the top of my head, what comes to my mind is. This whole concept of fragmentation on the payer side, right? Uh, especially in the US healthcare system. And, uh, we in biopharma are often, um. Complaining that it's too fragmented, too challenging, and it's, it's, it's not possible and it is beyond [00:43:00] repair.
I think what my advice to, you know, leaders like, uh, Cri and uh, and Biopharma is, uh, would be that, you know. Market access in 2026 is no longer about winning every negotiation with PBM. It is about, uh, what I would say managing the trade-offs, right? If PBM says No, put patients to cash. GLP one have demonstrated that employer says, uh, something is too expensive, offer them outcomes based contract. government says, uh, well, it's too high, then manufacturers can accept, uh, MFP in return for. Larger volume. that's what I, I think, I think we [00:44:00] should focus more on what are the tradeoffs and what is feasible within the context of those tradeoffs. Rather than complain about healthcare system and its fragmentation.
Syam Palakurthy: Yeah. I, I love that it's very realistic and, uh, realism driven, but very actionable. Cree, how about you?
Cristina Masseria: So I would, um, ask them to talk more among each other’s and, uh, because at the end of the day, we all share the same objective, which is improving the health of the society. And making sure the right patients gets the right medicine at the right time. Because all of us, wherever we sit, we are patients and or we have patients in our families, right?
So I feel we need to improve the level of trust and collaboration and dialogue. [00:45:00] if we are able to do that, I feel that a lot of those misincentives and fragmentation. Can be resolved. And that is going back to Amitabh, right? We can find a different way of doing things, but we can only do that if we have a very honest and open dialogue where we are listening to each other's needs and we try to find productive and efficient solutions together.
Syam Palakurthy: Yeah.
Indranil Bagchi: And not much more to add on my end, I think we started the conversation with fragmentation of the healthcare system. I would end the conversation and the exact opposite place, which is how can we get to a holistic approach to healthcare? And I think that's what both Cristina and Amitabh alluded to.
Uh, every different stakeholder has a different role to play. They have different needs, they have different skills and capabilities. Which requires us to engage in dialogue, which Cristina has already referred to. [00:46:00] It also requires us to put each other in other shoes and try to understand where they're coming from and what they're bringing to the table.
But in the end, if we can have a more holistic approach to healthcare, make prevention along with treatment, a part of the whole cycle, and in the end, making sure in whether it's. A long-term view, whether it's view across different segments, we have the ultimate patient benefit in mind and drive towards that.
I'm confident we can improve access to medicines and thereby make the world a better place. So putting a plug for holistic healthcare. And thank you for inviting us to this podcast.
Syam Palakurthy: Yeah. Well that, that seems like a really wonderful note to end on. Thank you all for taking the time. I know you're in different time zones, different parts of the world. Uh, so we're, we're thrilled that we could get the three of you in your brains in one place, in one conversation together.
Kip Theno: Yes. Thank you all. And I always end with an Easter egg question, by the way, Sean, thank you for [00:47:00] as usual, masterful. Um, look, we spend 17% of our GDP here and I don't think we're going to solve this overnight 'cause the trouble certainly didn't happen. 24 hours ago, but we'd love to have you back on to talk about access cost prevention, the great debate on PBMs, which is pretty hot topic here right now.
Payer uniformity. So here's my Easter egg question, and again, thank you all for your time. I dunno if you saw the big news, but steak has just been put back at the top of the pyramid in uh, in our dietary plans. I don’t know if you saw that it was moved back to the top and I've got three doctors on up or thumbs down.
I'm personally very pleased with that decision.
Amitabh Singh: How can I put a thumbs down for steaks?
Kip Theno: one, uh, that's a sideways, uh, that's a thumbs down. All right. I ate the final vote. Two to one. Two to two. We tied. Okay. Thank you guys. Hey, again, happy New Year. Appreciate y'all being on the show. Um, 2026 off to a great [00:48:00] start on the Road to Care podcast and, and again, together we can make things right.
Look forward to seeing you again this year. Thank you all.
Indranil Bagchi: Thank you very much.
Cristina Masseria: you.
Amitabh Singh: Thank you.
Syam Palakurthy: Thank you all.
Thank you for joining the Road to Care podcast, hosted by SamaCare, the leader in prior authorization technology and services, where through a script to therapy operating system, we enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced, and recorded by Jamestown.
Podcast produced by JFACTOR, visit https://www.jfactor.com/
Together, we can make healthcare right. Here are some of the outstanding healthcare organizations and associations championing patient health mentioned in this episode:
[00:00:00]
Welcome to the Road to Care podcast hosted by SamaCare, where we'll talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today. And where we see it evolving some care's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together we can simply make things right.
Kip Theno: Okay, welcome back to The Road to Care podcast everybody and happy 2026. I can't believe it's here. As you can see, we've got a brand new studio. We've got fancy headphones we've splurged for, uh, and, uh, we're looking forward to a great show. We've got a panel of three doctors today and our CEO, Syam Palakurthy.
Our panel Dr. Amitabh Singh, Dr. Indranil Bagchi, and Dr. Cristina Masseria. Dr. Singh is a highly experienced and accomplished leader in [00:01:00] market access, health, economics, and real-world evidence generation.
With nearly 30 years of experience in major pharmaceutical companies such as AbbVie, Wyeth, Pfizer, and Novartis, Dr. Singh is passionate about building scalable and groundbreaking capabilities to enhance value, differentiation, and demonstration. And a proven track record of leading successful teams in areas such as value and access, pricing and reimbursement, and evidence generation.
Dr. Singh has an M. Phil. in international trade and econometrics, and a PhD in economics. Dr. Singh retired two years ago in his final position, he held the role of Worldwide Head and vice president of HEOR, in Novartis oncology.
Dr. Bagchi currently serves as global head of pricing and market access at GSK, where he drives overall strategy on value demonstration, and market access across all product areas.
In the GSK portfolio, Dr. Bagchi has extensive experience and proven track record of leading value and access pricing, [00:02:00] reimbursement, and health outcomes functions in major companies, including GlaxoSmithKline, Wyeth, Pfizer. Novartis, Dr. Bagchi has an MS in healthcare administration and a PhD in pharmaceutical socioeconomics.
Dr. Masseria currently serves as vice president of value and access for AESARA, a digital forward market access agency. Prior to that, Dr. Masseria served as vice president patient health and impact hospital and vaccine business units at Pfizer and worked in health outcome vaccines. At GSK. Dr. Masseria began her career in academia.
As a health economics researcher and lecturer at the London School of Economics and Political Science LSC. Dr. Masseria has an MSC in health economics and a PhD in economics.
I do want to take a quick minute to thank Jillian Kushner (jfactor.com), our program director, all our listeners. Our viewers and subscribers and of [00:03:00] course our guests in 2025 making R2C Road to Care podcast, one of the top healthcare podcasts in the country. Um, and as we do, sometimes I will not just be the host with the microphone.
I'm going to pass that golden mic, the torch, over to Syam Palakurthy, our CEO of SamaCare to start with the intros and have a robust discussion. So welcome back everybody.
Syam Palakurthy: Great. Well, thank you Kip and thank you everyone for listening. We are super, super excited about this conversation today. We have not just a panel which is new for us, but also a panel of absolute global pharma All Stars. They have seen so much, across so many different regulatory landscapes and so many different, drug launches. So real excited for this. Maybe I, will start with having, each of the three of you just tell us a little bit about your background. What drew you to healthcare in the first place and, and to health economics and into market access. Amitabh, let's start with [00:04:00] you.
Amitabh Singh: Hi. A very good morning to all my fellow panelists. Uh, so just a 20 second, uh, spiel for me. I came from academia as an economist. I would say the work was intellectually rewarding but abstract. What pulled me into health, economics and market access was a chance to apply that rigor real world decisions.
Where the analysis or the work I do affects the access to innovative medicine that Biopharma is producing. So that's what attracted me.
Syam Palakurthy: Uh, thank you so much, Amitabh. And Cristina (Cri), will you tell us a little bit about what brought you into this, this landscape, what brought you into this world?
Cristina Masseria: Thank you and nice to be here. And similar to Amitabh, I started in academia where I was for more than 10 years in Europe advising actually many [00:05:00] countries on healthcare reform and how to introduce health technology assessment for assessing medicines. And then similar to Amitabh, I felt that although it was.
Really important work advising policies. I was not really making an impact, a clear impact on the patients and all what the pharma industry and all the innovations that were emerging, and that is where they need to join Pharma. And be involved myself in developing the type of data that beyond the clinical trial, can help us show the value of the medicines, in particularly when we negotiate with budget orders. Because often the data we create from the clinical trials are not sufficient to fully demonstrate the value across the whole population and in different sectors and long term. So, very pleased to be here.
Syam Palakurthy: Awesome. Thank you so much, Cri. [00:06:00] in can you tell us about what was it that brought you to healthcare economics, market access and pharma.
Indranil Bagchi: Yeah, absolutely. Thank you Syam, and good morning. Good afternoon. A real pleasure to be here. Thank you for having me on this podcast on my end. Having grown up in India and having seen the disparities of care across populations and seeing the increasing need for Innovation in the healthcare space and the need to make people live longer and live better lives.
When I was thinking of a career, there was no better option than focusing on market access and working with the large healthcare systems to ensure medicines are accessible to as many patients around the world as possible and making the world a healthier place along the way. So again, really pleased to be here and look forward to the discussion.
Syam Palakurthy: Yeah. That's great to hear. Thank you Indranil. And I think what's, what's interesting to hear from all three of you is just this through line of how do we translate these, these really [00:07:00] interesting sets of ideas into impact for patients. And, and even though you're all coming from fairly different backgrounds and fairly different, uh, parts of the world, that that through line seems pretty clear.
So it's, it's really exciting to. To hear from you on this now.
Syam Palakurthy: Now, one of the other things that we're, we are really excited about is we, we don't spend a lot of time on this podcast talking about the global perspective and how that differs, informs, is informed by the US. And, and given the background that you all have, we're really excited to kind of dive into that and to, to get in there. So, so can you tell us, what, what are the challenges and opportunities, and maybe am, I'll start with you. The challenges and opportunities that you see when it comes to, and particularly this idea of value, for a given treatment. How does that differ when it's in the US versus, the global perspective?
Amitabh Singh: Yeah. Thank you Syam. So let me take a crack. It's a question that deserves, [00:08:00] maybe two, three hours, but I'll try to summarize it in two, three minutes. I think when it comes to definition of value, the fundamental difference between US and the rest of the world, it stems from the difference in the structure of healthcare system as well as the assessment framework, which they use value assessment framework that they use, uh, given the difference in structure of healthcare systems? Uh, think if you look at three things I'll say, if you look at us, uh, it's a fragmented pair system, both horizontally as well as vertically. There are a hundred plus commercial payers. . There's Medicare, there's uh, Medicaid, there's, uh, VA system. Even vertically, if you were to look at, there are more than 60 PBMs, as opposed to that,
in Europe, it is [00:09:00] primarily a single healthcare system, a single payer healthcare system. I think, uh. What is also the second point, what is also important is that there's no universally accepted value framework in the US. Uh, whereas, uh, if you look at the European side, there's an implicit or explicit, uh, effectiveness threshold that determines the value. The third thing I would say, again, it stems from the value assessment framework. There's no universally accepted comparative for value assessment when you're launching a new drug. In US, it's market driven. In Europe, it's mandated by HTAs. So, if I were to summarize it, what I would say is that in the absence of a universal value framework, value is negotiated across different payers in US. In Europe, it is formally assessed, [00:10:00] through a centralized HTA framework. Now, what are the some of the challenges related to that? I think the challenges in demonstrating value, number one, I would say is this whole concept of rebate wall where value it gets obscured by a rebate system. A drug may be of high clinical value, but it may be of low value to the PBM the competitor offers greater rebate.
The second point is related to challenges, is especially in the US it's uh, increasing. Political, what I would say interventions, I think Most Favored Nation is one. Um, IRA is the second one. And on top of it, the access environment itself is getting more and more, challenging. And then I think in US, there's no mechanism for seeking [00:11:00] scientific advice for designing a trial right. That is solely absent in us. That's a huge challenge for us. On the European side, I would say that there's a very narrow definition of value. And clinical benefit, uh uh, it's often driven by hard clinical endpoint and not all dimensions of value get captured. Then on the value erosion side, I think, it's very mechanistic on the European side that IRP actually govern. How, how, your price evolves over time. It is disconnected from demonstration of value over time. So those are some of the challenges that I would highlight. Let me stop here.
Cristina Masseria: Maybe if I can add, I think Amitabh did an amazing overview and as he said, I think we could. Talk about it for hours. And I think you have the three best people to do that. And uh, your [00:12:00] question is actually very relevant because we are in a moment in which value assessment is changing and uh, and there is a lot of uncertainty as well. So there is change and uncertainty, which is not great. Clearly, there is at the moment a big focus on the cost of pharmaceuticals. In the US and globally, and, I think we're all aware of recent policies and promoted by the current administration to introduce reference pricing in the US and to leverage, the other biggest economies, eight biggest economies in the world for reference pricing and, uh. Reference pricing and value assessment are really not similar because when we talk about us, for example, leveraging France Germany as a reference for the pricing, it would mean that the value approach that France is using would be similar to the [00:13:00] value approach the US is. And we know this is very, very different. So something also to emphasize. Amount of resources the US spends on healthcare is very different than the amount of resources France or Germany spends on healthcare versus GDP, because overall, I think the value and the cost, not just pharmaceuticals for. An X-ray or MRI is very different in the US than it is in Germany, France, and Japan.
Right now, when we start saying for pharmaceuticals, we want to use the same level of pricing, but we are not using the same level of pricing for all the other medical intervention or healthcare costs. We are creating some discrepancies and that can actually. Thise investment from pharmaceutical companies. And , [00:14:00] I think we are in a moment in which the US, I think, is still deciding where they should go and what is the best approach. I don't think we are at the arrival line. think we are still running and identifying what is the best approach also for the US to assess value. But I wanted to emphasize reference pricing is not a value assessment tool. Right? And I think it's very important to, to clarify that.
Syam Palakurthy: Yeah, that's a really great point, Cri, because we, we are hearing a lot more about the kinds of reference pricing or using of pricing abroad determined pricing here, but it's not necessarily the same as. As value. Um, and, and there can be some different implications based on how different countries or different cultures value, you know, different parts of the, the healthcare.
Syam Palakurthy: And, and that actually maybe, and Indranil, I'd love to ask this next question to you, I guess is this, um, [00:15:00] question that I think sometimes comes up when people compare the US to outside the us, which is, the way that we treat prevention versus intervention. Can you talk about Indranil, how are biopharmas looking at the difference between, focusing on prevention versus focusing on intervention? Would, would love to hear that in particular, how you think that affects the US as you know, we, we have so much talk right now and over the last really two decades about like, how do we focus on prevention and preventive care more?
Indranil Bagchi: Yeah, absolutely. Thank you for the question, Sam. So what are the implications of prevention versus intervention for biopharma? I would say too often our health systems are focused on reactive treatment. As we all know, we call this a healthcare system, but actually it's more of a sickness care system, not really a system designed to promote health.
So only around 3% of total health [00:16:00] spending is actually dedicated to prevention across all the countries. Meaning people live with diseases that could have been prevented or controlled earlier, and the health systems that must deal with those consequences of not treating those diseases earlier. However, we believe that prevention is the best medicine for patients, societies, health systems and economies.
Investing in prevention delivers better health outcomes is cost effective and healthier people. This is nothing groundbreaking. Elder people are better able to contribute economies and societies at large. So for every $1 invested in improving health, an economic return of between two and $4 is possible.
But for vaccines, it's seven higher, it could be up to $9, and by 2040, health improvements could add 12 trillion to the global GDP. So as we all think about how to help people live healthier lives, there is a clear opportunity to shift from funding sickness systems, as I mentioned before, [00:17:00] to investing in health, enabling earlier action to prevent, diagnose, and treat disease, which would also improve the trajectory of economic growth.
However, this wouldn't happen on its own. Again, as I said. Today, incentives in most healthcare systems around the world, including the US, is geared towards treatment. There needs to be a fundamental shift to encourage more prevention upfront to prevent consumers, patients, to slide down to more costly and more complicated morbidity areas.
Yeah.
Cristina Masseria: If I can add some. So I think as Indranil knows I'm a big fan of prevention and I've worked for many years in vaccines, and I fully agree with what he was saying, one of the harder in doing so is budgeting and often prevention budget and, uh, medicine intervention budget are separate. And so you have also the challenge. Also, [00:18:00] prevention means long-term planning. Often when we think about budgeting for most of the budget holder, we're talking about one or two years budgets. And uh, and you will see the impact of prevention only long term, but in today's society, where we have a huge number of chronic conditions that are actually causing the huge healthcare expenditures for our economies. Prevention is the solution. Because, uh, ma of these chronic condition could be prevented. They are preventable. And even if maybe you cannot avoid them, you can delay the onset and, or the impact of this and something that we need to keep in mind, right? But there are some barriers need to be tackled to make sure that there are the right incentives, as Indranil was saying.
Syam Palakurthy: Yeah. Yeah. I like this. This idea too, of [00:19:00] there're being, there're being actual value in, in ROI for a country to actually invest in the prevention side. I, I'd love to hear, um, Amitabh, maybe if you could talk about, does, does that require a different approach to building a drug to, to identifying the molecule to, to launching the drug that, that focus on prevention.
And if so, how does it change what, what biopharma does need to do, um, to, to really launch more of those preventive drugs.
Amitabh Singh: Thank you Syam. Uh, That's what Indranil was describing and Cri was following up, that's what I was thinking, in terms of what it would take and what is fundamentally different for prevention versus treatment. I think one point I'll make is, when you're talking of prevention, value is harder to prove or establish. Uh, prevention [00:20:00] is, uh, related to benefits that accrue over the longer term. So that's one. The second problem related under the same heading would be that, outcomes are often probabilistic. So it's not determinate, you know, it's probabilistic . You can sometimes try to bridging with surrogate markers, uh, in short term, but that generates uncertainty for the payers that they're not sure whether this will happen, right? fundamentally, value becomes difficult to establish in the short term, and the traditional paradigm of randomized clinical trial does not work anymore. Uh, related to that is know, shift in evidence requirement. So, for example, I would give you two, three examples here. Repatha launched in 2015. But their [00:21:00] outcomes data did not come till 2017. Now, if payers are saying that we will not cover you till the outcomes data comes, then you have lost those two valuable years. Right? if you look at Eliquis, that Aristotle trial came in 2015, the data on reduction in bleeding and stroke came not till 2018. 2019 timeframe. Right? So the question becomes how do we better align with the traditional randomized clinical trial? Or is there a different avenue together to establish the value of prevention? So that's the, you know, fundamental shift. I think if you look at how biopharma adapting, really the bridging link has to be something, has to do [00:22:00] something related to, Either outcome-based, uh, contracting or some warranty or preferential access for preventive therapy. So if you look at Pharma biopharma, they're already experimenting with newer models of value-based, uh, contracting. Also, if you look at pharma, they are now increasingly moving to beyond the pill solutions, right? with, uh, digital healthcare companies or diagnostic companies. That has become a traditional model for, has become embedded in the traditional thinking of biopharma. So those are some of the things that are already happening and. Also, I would say if you think of, uh, not primary prevention, if you think of secondary and tertiary prevention, pharma has invested traditionally, I mean, I would think [00:23:00] of it differently, has invested traditionally in prevention area, right? So for example, if you think of, early neurogenerative diseases. These are all prevention models, right? Uh, you think of Parkinson's, you think of a ALS, you think of ms, you think of Alzheimer's. These are all prevention models, right? You think of cardiometabolic diseases, right? GLP-1 explosion. These are all preventative therapy, right? If you look at oncology interception, these are all preventive models that Biopharma is investing. So it'll take time. I don't think this is, uh, I don't think this can be completely. Uh, can completely move to a paradigm which says that, you know, biopharma is not investing, uh, heavily in prevention.
Yes, they are where the [00:24:00] ROI is and they're not in certain areas where they could do a better job, but fundamentally the structure has to evolve. Structure of RCT structure of how we demonstrate value has to evolve.
Syam Palakurthy: thank you, Amitabh. But I'd love to Cri, turn this next question over to you. It relates to, Amitabh was just saying and what we were saying earlier around the different systems that the US has versus the rest of the world, where potentially it's less determined by national body or by a specific value body, but individual insurance companies. I'm curious. Cri, do you have any thoughts on what needs to change in terms of the incentives given that you have individual insurance companies in the US that are determining that, that value, um, to make it so that it, it makes more sense. And, you know, like, like, I mean, have said there are, there are drugs that, that we have in the market that are preventive focused.
There have been, uh, areas that, that's happening. What [00:25:00] needs to change in terms of the incentives to, to make that, uh, an even bigger focus.
Cristina Masseria: So, as I was saying, we are investing in prevention. Pharma is investing in prevention, and uh, also we know that the budget orders are interested in particular certain, systems more than others. One area I was mentioning before is really the need to look budget differently. So many of the commercial payers, when they do their budgeting decision in really short term, is one year, two years, maximum, three years, as we were saying.
Often for this preventive medicine, you will see the outcome only in the long term. And this horizon might not be sufficient really to demonstrate the value that, you are giving to a patient or to your population by providing these medicines. And this is why Amitabh, I will say one way is to use alternative [00:26:00] approaches with outcome based agreement or value agreement, but they can span across a longer time horizon than potentially the budget that the payers or the insurance companies are holding. this in the past sometimes is creating some. Miscommunications and, but I think we're all working through this and now a lot of the insurance companies, and they have actually value agreement and outcome based agreement as a objective as well. And so they're really moving forward to use more and more this type of.
Tools to demonstrate the value in particular because as Amitabh was saying, for a lot of these inter medications, the clinical trial is short term, often not even from the clinical trial, we can fully demonstrate the long term value and therefore it's very hard even when we have those pricing discussions to align on those [00:27:00] what is the real value for the medicine? And that is when those outcome agreement are very important. And now there is the beauty, there is data everywhere, right? So the insurance companies, they have their own data. They can look at the data the way the pharma companies can look at the data and we can collaborate together, identify what are the right outcomes, what do we wanna measure.
What is the right time horizon for this measurement and adapt our pricing according to the results that we see over time. but as you can imagine, different, these negotiations are happening across a multitude of insurance companies. So it's very complex. While in Europe, let's say you're doing it maybe just with differential authority, once in the US you have to do it many times and uh, and potentially you have different outcomes. With different insurance companies. So you have different models. So you can imagine [00:28:00] the level of complexity. It's, it's quite elevated and what can happen is potentially in one for one insure you are in the formulary for another one, you're not for one, you are preferred. For another one you're not. Right?
So that is why you see also these differences across insurance in, in access and reimbursement of different medication.
Amitabh Singh: So one more thing. Actually let me stop. This is really near and dear to my heart this issue but, but let me, but let me stop and let Indranil comment.
Indranil Bagchi: Uh, not much more to add my, on my end. I mean, I think the miscellaneous incentives we have talked about the need to capture the right data. We have talked about. I think one specific challenge to the US is because of the fragmented healthcare system, you could be going through the process in a certain plan, but when the benefits accrue, you move to a different plan.
So unless there's portability of insurance within the US, that's [00:29:00] the challenge we run into, which we don't run into in a socialized healthcare systems like France that Cristina was describing. Having said that, every healthcare system has its challenges, but if some sort of portability of insurance can be done within the US that would encourage more preventive behavior.
And then the last thing we didn't talk about is a lot of this also behavioral, right? So. Obesity, substance use, et cetera. I mean, these are behavioral notions that cannot be just fixed by medical intervention. These need to be accompanied by behavioral changes, which also needs to be part of the overall regimen along with medical care and everything else.
So yes, the move towards preventive care is happening, but depending on the type of healthcare system, depending on the type of condition we are talking about, the challenges could be different, but nothing that cannot be addressed going forward. Thank you.
Amitabh Singh: So this is, uh, one concrete idea for you, um, this portability mechanism. Right. is something that we [00:30:00] have to work in us, uh, because of membership churn, and that's really, really the most important thing if we need to evolve towards prevention system. The other piece I would say, which is in the same spirit as Indranil said, is, you know, evolution of Benefit design to value-based insurance design. So if something is high value care, there should be low cost sharing, right? For patient US right now, it's exactly the opposite. If it is specialty care. It's very high cost for the patient. So value-based insurance design. That's the second piece that I would say that is, uh, that could happen. The third one is, I would say there has to be a separation between formulary, a formulary, uh, placement and rebate. So this could be done very easily [00:31:00] done by building transparency around, uh, rebate and spread pricing. Right. So that's the third concrete idea for you. And then the fourth one, I would say. There has to be some sort of preferential as I was saying, or coverage for preventive therapy, which is not currently happening. So those are three or four concrete ideas.
Syam Palakurthy: Yeah, I love, I love the concreteness of it. Um, we, we've been talking a lot about the incentives, how we incentivize Biopharmas, insurance companies, even patients, I'd love to hear if we just take a, a step back and, and if you could tell us, maybe Cri, starting with you, like what do you think are the, the biggest access challenges to patients actually for, for the drugs that have actually been launched? Um, or that, that where the molecule has been developed? What do you think the biggest access challenges are? And I'd love to hear your perspective on how it compares in the US versus outside of the [00:32:00] us.
Cristina Masseria: So often is, um, price, I think engineer talked about these, uh, actual discrepancies between value and the share price that the patients are paying where specialty care are extremely expensive in the US and, but they bring huge value to the patients. And, uh, we know that the level inequalities and capability to pay for the patients are very different and, and although pharma companies are often providing vouchers or supporting the patients to cover some of the cost of these medications. They are really substantial cost and they can decentivize the, the patients from continuing from starting the treatment and or [00:33:00] even from continuing the treatment because we, we are really talking about substantial cost and many families in particular. If you, if you're not. Very well off this, this might be very prohibitive. But the second element is also I think, a full understanding of the benefits of the medication. And, uh, and, and I think that is where the dialogue with the with your physicians and now everything is available online. Sometimes it's an advantage, some is a disadvantage because you read so much and you make your own interpretation of things and uh, uh, and we know what we know.
We don't know what we don't know. And, uh, and not often. We don't know what we don't know. And uh, so I always say that for me, uh. the wealth of information that is out there. It's, uh, it's amazing, but [00:34:00] it's, it's also difficult and to digest and that is very important to, to have those very good conversation with your physicians and the experts and to really understand What can be the advantages and disadvantages of this medication in particular where we think about that potentially are taking a variety of medications and there could be side effects or implication of using multiple medications. You really need to understand and know all the potential adverse events and implication that this can have on your body and on your quality of life. And often we don't. The other element that is important in the clinical trial, not often we collect those endpoints that are relevant for the patients. And uh, we are looking at, um, say for a cancer medication, right, the probability of leaving 3, 4, 5, 6 months more. [00:35:00] What if actually those 3, 4, 5, 6 months more, you spend them in a bathroom? Because you're showing up, right? So. That is not good for the patient. So clearly the patient doesn't have an incentive in taking the medication, but not often, or now we're doing more and more, and even FDA's investing on this. There is a huge now framework to push forward to really collect those endpoints that are relevant to the patients in terms of their quality of life, but also their experience. And, uh, with, uh, the healthcare system and the impact, the disease on their daily life daily routine capability to work to bring their kids to school or to the park. Because this has a huge impact on the probability of taking those medications.
Syam Palakurthy: Yeah, that makes a lot of sense. Thank you.
Syam Palakurthy: And I [00:36:00] want to ask this because it's so, uh, it's so topical right now. We're seeing artificial intelligence being implied to. Lot of different areas at the moment. Uh, maybe Indranil I'll ask you this question, do you have any thoughts on, and, and I'd love to hear from Amitabh and Cri and as well, do you have any thoughts on where can artificial intelligence have an impact on the, you know, the value, access and pricing side and where, where do you think it's just not going to make that much of a difference?
Indranil Bagchi: Thank you, Syam, for the question. Of course, I mean, artificial intelligence is the next big thing that we are all looking for the proof to happen. And, uh, I, I know it's being applied in many different areas. I think the application to healthcare may have been somewhat slower than some of the other industry that we are familiar with.
When it comes to access, where can it help the most? It can help with predictability in the end, drug development and access to medicines. The biggest piece that gets [00:37:00] along the way is uncertainty of science, and that's where AI can step in. And just by simply looking at previous results that have been obtained and digging into those databases and help us plan better clinical trials, making sure the right population is included, making sure the right endpoints are included, and if we do all of that,
what could be the predictability of the results clinically humanistically, economically, and driven by that, what could be the corresponding access. So I think that's where industry as well as the different stakeholders are trying to apply artificial intelligence. And by applying it successfully, if we can take some of the time lag out, so reduce the time to drug development.
As well as take some of the cost out, reduce the cost of drug development, that could be a significant contribution to human society. So I would say yes, if you have to focus on one area, that would be removing uncertainty. And the way we are doing pilots in terms of how we're applying AI is [00:38:00] as we have to respond to the different, you know, assessment agencies, health technology, assessment agencies.
It's just using AI to be able to respond quickly just in time, and thereby reducing the need to engage in meetings and thereby reducing the need to wait and improving time to access to medicines. Yeah.
Amitabh Singh: So two or three points here, uh, in addition to, I think Indranil alluded to use of technology to enhance the. Uh, RCPs, uh, randomized clinical trial. One way we should think about, uh, AI is that it has dramatically reduced the cost of doing, uh, real world evidence, collecting real world evidence data, right? So obviously, what are some of the ways in which real world evidence can be scaled up with the help of ai? not an expert in ai, but that's, uh, one of the opportunity. I [00:39:00] think the second piece where AI can help us is in what I would say, identification of subpopulations, uh, where the patient is more likely to, uh, respond to a particular treatment.
Right. Uh. That actually feeds into how you can better design your clinical studies to demonstrate value, right? if you can identify those subpopulation and if you can recruit based on that, uh. Avoiding the bias that is inherent in that kind of design. If you can do that, that is, uh, really important. And the third piece I would say, and this is getting into the technical, uh, aspects, but AI has, uh, enabled us to now, um, and NICE is using it, uh, [00:40:00] is called dynamic economic model. So your cost effectiveness, uh. Models are continuously updated in real time, on a real time basis. So those are two or three ideas that comes to mind off the top of my head.
The final piece I would say is that can we deploy AI to identify where value-based contracting has worked well in the past, and then learn from that and apply that both in the payer and healthcare system setting as well as for biopharma.
Syam Palakurthy: Great. Thank you. And crew. Any anything you'd want to add to that?
Cristina Masseria: I think Indranil and Amitabh covered most of it. And as Amitabh said, where it's just the beginning. I think for me, 2025 was the boom and uh, everything now is in front of. Us [00:41:00] in 2026 will be the moment where actually we're going to see some of the results also in healthcare. And, uh, because some of those applications now are becoming real and we see the real impact. I think this will be, will be a year, I suppose, full of, um, of those results of using AI and gaining more efficiencies and more predictability as Indranil mentioned, which is key for budgeting.
Syam Palakurthy: Yeah, that makes sense. And, and I know we're, we're gonna have to start wrapping, uh, the conversation. As you might know, we, we have listeners who come from the provider side, from the biopharma side, the payer side, and even some of the, the policy making and regulatory side. love for, for each of you and maybe starting with Amitabh and then Cri and then Indranil. If you just have one piece of advice or one recommendation, and you can, you can direct it to any of those four stakeholders, the provider, biopharma, [00:42:00] uh, the payer or the regulatory side. What, what one piece of advice or ask would you make, um, to, to one of those groups to kind of move this forward so more patients are able to get on the right treatment at the, the right moment in time.
Amitabh Singh: Yeah. Wow. That's a big question. Uh, Sam, uh. I think off the top of my head, what comes to my mind is. This whole concept of fragmentation on the payer side, right? Uh, especially in the US healthcare system. And, uh, we in biopharma are often, um. Complaining that it's too fragmented, too challenging, and it's, it's, it's not possible and it is beyond [00:43:00] repair.
I think what my advice to, you know, leaders like, uh, Cri and uh, and Biopharma is, uh, would be that, you know. Market access in 2026 is no longer about winning every negotiation with PBM. It is about, uh, what I would say managing the trade-offs, right? If PBM says No, put patients to cash. GLP one have demonstrated that employer says, uh, something is too expensive, offer them outcomes based contract. government says, uh, well, it's too high, then manufacturers can accept, uh, MFP in return for. Larger volume. that's what I, I think, I think we [00:44:00] should focus more on what are the tradeoffs and what is feasible within the context of those tradeoffs. Rather than complain about healthcare system and its fragmentation.
Syam Palakurthy: Yeah. I, I love that it's very realistic and, uh, realism driven, but very actionable. Cree, how about you?
Cristina Masseria: So I would, um, ask them to talk more among each other’s and, uh, because at the end of the day, we all share the same objective, which is improving the health of the society. And making sure the right patients gets the right medicine at the right time. Because all of us, wherever we sit, we are patients and or we have patients in our families, right?
So I feel we need to improve the level of trust and collaboration and dialogue. [00:45:00] if we are able to do that, I feel that a lot of those misincentives and fragmentation. Can be resolved. And that is going back to Amitabh, right? We can find a different way of doing things, but we can only do that if we have a very honest and open dialogue where we are listening to each other's needs and we try to find productive and efficient solutions together.
Syam Palakurthy: Yeah.
Indranil Bagchi: And not much more to add on my end, I think we started the conversation with fragmentation of the healthcare system. I would end the conversation and the exact opposite place, which is how can we get to a holistic approach to healthcare? And I think that's what both Cristina and Amitabh alluded to.
Uh, every different stakeholder has a different role to play. They have different needs, they have different skills and capabilities. Which requires us to engage in dialogue, which Cristina has already referred to. [00:46:00] It also requires us to put each other in other shoes and try to understand where they're coming from and what they're bringing to the table.
But in the end, if we can have a more holistic approach to healthcare, make prevention along with treatment, a part of the whole cycle, and in the end, making sure in whether it's. A long-term view, whether it's view across different segments, we have the ultimate patient benefit in mind and drive towards that.
I'm confident we can improve access to medicines and thereby make the world a better place. So putting a plug for holistic healthcare. And thank you for inviting us to this podcast.
Syam Palakurthy: Yeah. Well that, that seems like a really wonderful note to end on. Thank you all for taking the time. I know you're in different time zones, different parts of the world. Uh, so we're, we're thrilled that we could get the three of you in your brains in one place, in one conversation together.
Kip Theno: Yes. Thank you all. And I always end with an Easter egg question, by the way, Sean, thank you for [00:47:00] as usual, masterful. Um, look, we spend 17% of our GDP here and I don't think we're going to solve this overnight 'cause the trouble certainly didn't happen. 24 hours ago, but we'd love to have you back on to talk about access cost prevention, the great debate on PBMs, which is pretty hot topic here right now.
Payer uniformity. So here's my Easter egg question, and again, thank you all for your time. I dunno if you saw the big news, but steak has just been put back at the top of the pyramid in uh, in our dietary plans. I don’t know if you saw that it was moved back to the top and I've got three doctors on up or thumbs down.
I'm personally very pleased with that decision.
Amitabh Singh: How can I put a thumbs down for steaks?
Kip Theno: one, uh, that's a sideways, uh, that's a thumbs down. All right. I ate the final vote. Two to one. Two to two. We tied. Okay. Thank you guys. Hey, again, happy New Year. Appreciate y'all being on the show. Um, 2026 off to a great [00:48:00] start on the Road to Care podcast and, and again, together we can make things right.
Look forward to seeing you again this year. Thank you all.
Indranil Bagchi: Thank you very much.
Cristina Masseria: you.
Amitabh Singh: Thank you.
Syam Palakurthy: Thank you all.
Thank you for joining the Road to Care podcast, hosted by SamaCare, the leader in prior authorization technology and services, where through a script to therapy operating system, we enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced, and recorded by Jamestown.
Podcast produced by JFACTOR, visit https://www.jfactor.com/
Together, we can make healthcare right. Here are some of the outstanding healthcare organizations and associations championing patient health mentioned in this episode:
[00:00:00]
Welcome to the Road to Care podcast hosted by SamaCare, where we'll talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today. And where we see it evolving some care's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together we can simply make things right.
Kip Theno: Okay, welcome back to The Road to Care podcast everybody and happy 2026. I can't believe it's here. As you can see, we've got a brand new studio. We've got fancy headphones we've splurged for, uh, and, uh, we're looking forward to a great show. We've got a panel of three doctors today and our CEO, Syam Palakurthy.
Our panel Dr. Amitabh Singh, Dr. Indranil Bagchi, and Dr. Cristina Masseria. Dr. Singh is a highly experienced and accomplished leader in [00:01:00] market access, health, economics, and real-world evidence generation.
With nearly 30 years of experience in major pharmaceutical companies such as AbbVie, Wyeth, Pfizer, and Novartis, Dr. Singh is passionate about building scalable and groundbreaking capabilities to enhance value, differentiation, and demonstration. And a proven track record of leading successful teams in areas such as value and access, pricing and reimbursement, and evidence generation.
Dr. Singh has an M. Phil. in international trade and econometrics, and a PhD in economics. Dr. Singh retired two years ago in his final position, he held the role of Worldwide Head and vice president of HEOR, in Novartis oncology.
Dr. Bagchi currently serves as global head of pricing and market access at GSK, where he drives overall strategy on value demonstration, and market access across all product areas.
In the GSK portfolio, Dr. Bagchi has extensive experience and proven track record of leading value and access pricing, [00:02:00] reimbursement, and health outcomes functions in major companies, including GlaxoSmithKline, Wyeth, Pfizer. Novartis, Dr. Bagchi has an MS in healthcare administration and a PhD in pharmaceutical socioeconomics.
Dr. Masseria currently serves as vice president of value and access for AESARA, a digital forward market access agency. Prior to that, Dr. Masseria served as vice president patient health and impact hospital and vaccine business units at Pfizer and worked in health outcome vaccines. At GSK. Dr. Masseria began her career in academia.
As a health economics researcher and lecturer at the London School of Economics and Political Science LSC. Dr. Masseria has an MSC in health economics and a PhD in economics.
I do want to take a quick minute to thank Jillian Kushner (jfactor.com), our program director, all our listeners. Our viewers and subscribers and of [00:03:00] course our guests in 2025 making R2C Road to Care podcast, one of the top healthcare podcasts in the country. Um, and as we do, sometimes I will not just be the host with the microphone.
I'm going to pass that golden mic, the torch, over to Syam Palakurthy, our CEO of SamaCare to start with the intros and have a robust discussion. So welcome back everybody.
Syam Palakurthy: Great. Well, thank you Kip and thank you everyone for listening. We are super, super excited about this conversation today. We have not just a panel which is new for us, but also a panel of absolute global pharma All Stars. They have seen so much, across so many different regulatory landscapes and so many different, drug launches. So real excited for this. Maybe I, will start with having, each of the three of you just tell us a little bit about your background. What drew you to healthcare in the first place and, and to health economics and into market access. Amitabh, let's start with [00:04:00] you.
Amitabh Singh: Hi. A very good morning to all my fellow panelists. Uh, so just a 20 second, uh, spiel for me. I came from academia as an economist. I would say the work was intellectually rewarding but abstract. What pulled me into health, economics and market access was a chance to apply that rigor real world decisions.
Where the analysis or the work I do affects the access to innovative medicine that Biopharma is producing. So that's what attracted me.
Syam Palakurthy: Uh, thank you so much, Amitabh. And Cristina (Cri), will you tell us a little bit about what brought you into this, this landscape, what brought you into this world?
Cristina Masseria: Thank you and nice to be here. And similar to Amitabh, I started in academia where I was for more than 10 years in Europe advising actually many [00:05:00] countries on healthcare reform and how to introduce health technology assessment for assessing medicines. And then similar to Amitabh, I felt that although it was.
Really important work advising policies. I was not really making an impact, a clear impact on the patients and all what the pharma industry and all the innovations that were emerging, and that is where they need to join Pharma. And be involved myself in developing the type of data that beyond the clinical trial, can help us show the value of the medicines, in particularly when we negotiate with budget orders. Because often the data we create from the clinical trials are not sufficient to fully demonstrate the value across the whole population and in different sectors and long term. So, very pleased to be here.
Syam Palakurthy: Awesome. Thank you so much, Cri. [00:06:00] in can you tell us about what was it that brought you to healthcare economics, market access and pharma.
Indranil Bagchi: Yeah, absolutely. Thank you Syam, and good morning. Good afternoon. A real pleasure to be here. Thank you for having me on this podcast on my end. Having grown up in India and having seen the disparities of care across populations and seeing the increasing need for Innovation in the healthcare space and the need to make people live longer and live better lives.
When I was thinking of a career, there was no better option than focusing on market access and working with the large healthcare systems to ensure medicines are accessible to as many patients around the world as possible and making the world a healthier place along the way. So again, really pleased to be here and look forward to the discussion.
Syam Palakurthy: Yeah. That's great to hear. Thank you Indranil. And I think what's, what's interesting to hear from all three of you is just this through line of how do we translate these, these really [00:07:00] interesting sets of ideas into impact for patients. And, and even though you're all coming from fairly different backgrounds and fairly different, uh, parts of the world, that that through line seems pretty clear.
So it's, it's really exciting to. To hear from you on this now.
Syam Palakurthy: Now, one of the other things that we're, we are really excited about is we, we don't spend a lot of time on this podcast talking about the global perspective and how that differs, informs, is informed by the US. And, and given the background that you all have, we're really excited to kind of dive into that and to, to get in there. So, so can you tell us, what, what are the challenges and opportunities, and maybe am, I'll start with you. The challenges and opportunities that you see when it comes to, and particularly this idea of value, for a given treatment. How does that differ when it's in the US versus, the global perspective?
Amitabh Singh: Yeah. Thank you Syam. So let me take a crack. It's a question that deserves, [00:08:00] maybe two, three hours, but I'll try to summarize it in two, three minutes. I think when it comes to definition of value, the fundamental difference between US and the rest of the world, it stems from the difference in the structure of healthcare system as well as the assessment framework, which they use value assessment framework that they use, uh, given the difference in structure of healthcare systems? Uh, think if you look at three things I'll say, if you look at us, uh, it's a fragmented pair system, both horizontally as well as vertically. There are a hundred plus commercial payers. . There's Medicare, there's uh, Medicaid, there's, uh, VA system. Even vertically, if you were to look at, there are more than 60 PBMs, as opposed to that,
in Europe, it is [00:09:00] primarily a single healthcare system, a single payer healthcare system. I think, uh. What is also the second point, what is also important is that there's no universally accepted value framework in the US. Uh, whereas, uh, if you look at the European side, there's an implicit or explicit, uh, effectiveness threshold that determines the value. The third thing I would say, again, it stems from the value assessment framework. There's no universally accepted comparative for value assessment when you're launching a new drug. In US, it's market driven. In Europe, it's mandated by HTAs. So, if I were to summarize it, what I would say is that in the absence of a universal value framework, value is negotiated across different payers in US. In Europe, it is formally assessed, [00:10:00] through a centralized HTA framework. Now, what are the some of the challenges related to that? I think the challenges in demonstrating value, number one, I would say is this whole concept of rebate wall where value it gets obscured by a rebate system. A drug may be of high clinical value, but it may be of low value to the PBM the competitor offers greater rebate.
The second point is related to challenges, is especially in the US it's uh, increasing. Political, what I would say interventions, I think Most Favored Nation is one. Um, IRA is the second one. And on top of it, the access environment itself is getting more and more, challenging. And then I think in US, there's no mechanism for seeking [00:11:00] scientific advice for designing a trial right. That is solely absent in us. That's a huge challenge for us. On the European side, I would say that there's a very narrow definition of value. And clinical benefit, uh uh, it's often driven by hard clinical endpoint and not all dimensions of value get captured. Then on the value erosion side, I think, it's very mechanistic on the European side that IRP actually govern. How, how, your price evolves over time. It is disconnected from demonstration of value over time. So those are some of the challenges that I would highlight. Let me stop here.
Cristina Masseria: Maybe if I can add, I think Amitabh did an amazing overview and as he said, I think we could. Talk about it for hours. And I think you have the three best people to do that. And uh, your [00:12:00] question is actually very relevant because we are in a moment in which value assessment is changing and uh, and there is a lot of uncertainty as well. So there is change and uncertainty, which is not great. Clearly, there is at the moment a big focus on the cost of pharmaceuticals. In the US and globally, and, I think we're all aware of recent policies and promoted by the current administration to introduce reference pricing in the US and to leverage, the other biggest economies, eight biggest economies in the world for reference pricing and, uh. Reference pricing and value assessment are really not similar because when we talk about us, for example, leveraging France Germany as a reference for the pricing, it would mean that the value approach that France is using would be similar to the [00:13:00] value approach the US is. And we know this is very, very different. So something also to emphasize. Amount of resources the US spends on healthcare is very different than the amount of resources France or Germany spends on healthcare versus GDP, because overall, I think the value and the cost, not just pharmaceuticals for. An X-ray or MRI is very different in the US than it is in Germany, France, and Japan.
Right now, when we start saying for pharmaceuticals, we want to use the same level of pricing, but we are not using the same level of pricing for all the other medical intervention or healthcare costs. We are creating some discrepancies and that can actually. Thise investment from pharmaceutical companies. And , [00:14:00] I think we are in a moment in which the US, I think, is still deciding where they should go and what is the best approach. I don't think we are at the arrival line. think we are still running and identifying what is the best approach also for the US to assess value. But I wanted to emphasize reference pricing is not a value assessment tool. Right? And I think it's very important to, to clarify that.
Syam Palakurthy: Yeah, that's a really great point, Cri, because we, we are hearing a lot more about the kinds of reference pricing or using of pricing abroad determined pricing here, but it's not necessarily the same as. As value. Um, and, and there can be some different implications based on how different countries or different cultures value, you know, different parts of the, the healthcare.
Syam Palakurthy: And, and that actually maybe, and Indranil, I'd love to ask this next question to you, I guess is this, um, [00:15:00] question that I think sometimes comes up when people compare the US to outside the us, which is, the way that we treat prevention versus intervention. Can you talk about Indranil, how are biopharmas looking at the difference between, focusing on prevention versus focusing on intervention? Would, would love to hear that in particular, how you think that affects the US as you know, we, we have so much talk right now and over the last really two decades about like, how do we focus on prevention and preventive care more?
Indranil Bagchi: Yeah, absolutely. Thank you for the question, Sam. So what are the implications of prevention versus intervention for biopharma? I would say too often our health systems are focused on reactive treatment. As we all know, we call this a healthcare system, but actually it's more of a sickness care system, not really a system designed to promote health.
So only around 3% of total health [00:16:00] spending is actually dedicated to prevention across all the countries. Meaning people live with diseases that could have been prevented or controlled earlier, and the health systems that must deal with those consequences of not treating those diseases earlier. However, we believe that prevention is the best medicine for patients, societies, health systems and economies.
Investing in prevention delivers better health outcomes is cost effective and healthier people. This is nothing groundbreaking. Elder people are better able to contribute economies and societies at large. So for every $1 invested in improving health, an economic return of between two and $4 is possible.
But for vaccines, it's seven higher, it could be up to $9, and by 2040, health improvements could add 12 trillion to the global GDP. So as we all think about how to help people live healthier lives, there is a clear opportunity to shift from funding sickness systems, as I mentioned before, [00:17:00] to investing in health, enabling earlier action to prevent, diagnose, and treat disease, which would also improve the trajectory of economic growth.
However, this wouldn't happen on its own. Again, as I said. Today, incentives in most healthcare systems around the world, including the US, is geared towards treatment. There needs to be a fundamental shift to encourage more prevention upfront to prevent consumers, patients, to slide down to more costly and more complicated morbidity areas.
Yeah.
Cristina Masseria: If I can add some. So I think as Indranil knows I'm a big fan of prevention and I've worked for many years in vaccines, and I fully agree with what he was saying, one of the harder in doing so is budgeting and often prevention budget and, uh, medicine intervention budget are separate. And so you have also the challenge. Also, [00:18:00] prevention means long-term planning. Often when we think about budgeting for most of the budget holder, we're talking about one or two years budgets. And uh, and you will see the impact of prevention only long term, but in today's society, where we have a huge number of chronic conditions that are actually causing the huge healthcare expenditures for our economies. Prevention is the solution. Because, uh, ma of these chronic condition could be prevented. They are preventable. And even if maybe you cannot avoid them, you can delay the onset and, or the impact of this and something that we need to keep in mind, right? But there are some barriers need to be tackled to make sure that there are the right incentives, as Indranil was saying.
Syam Palakurthy: Yeah. Yeah. I like this. This idea too, of [00:19:00] there're being, there're being actual value in, in ROI for a country to actually invest in the prevention side. I, I'd love to hear, um, Amitabh, maybe if you could talk about, does, does that require a different approach to building a drug to, to identifying the molecule to, to launching the drug that, that focus on prevention.
And if so, how does it change what, what biopharma does need to do, um, to, to really launch more of those preventive drugs.
Amitabh Singh: Thank you Syam. Uh, That's what Indranil was describing and Cri was following up, that's what I was thinking, in terms of what it would take and what is fundamentally different for prevention versus treatment. I think one point I'll make is, when you're talking of prevention, value is harder to prove or establish. Uh, prevention [00:20:00] is, uh, related to benefits that accrue over the longer term. So that's one. The second problem related under the same heading would be that, outcomes are often probabilistic. So it's not determinate, you know, it's probabilistic . You can sometimes try to bridging with surrogate markers, uh, in short term, but that generates uncertainty for the payers that they're not sure whether this will happen, right? fundamentally, value becomes difficult to establish in the short term, and the traditional paradigm of randomized clinical trial does not work anymore. Uh, related to that is know, shift in evidence requirement. So, for example, I would give you two, three examples here. Repatha launched in 2015. But their [00:21:00] outcomes data did not come till 2017. Now, if payers are saying that we will not cover you till the outcomes data comes, then you have lost those two valuable years. Right? if you look at Eliquis, that Aristotle trial came in 2015, the data on reduction in bleeding and stroke came not till 2018. 2019 timeframe. Right? So the question becomes how do we better align with the traditional randomized clinical trial? Or is there a different avenue together to establish the value of prevention? So that's the, you know, fundamental shift. I think if you look at how biopharma adapting, really the bridging link has to be something, has to do [00:22:00] something related to, Either outcome-based, uh, contracting or some warranty or preferential access for preventive therapy. So if you look at Pharma biopharma, they're already experimenting with newer models of value-based, uh, contracting. Also, if you look at pharma, they are now increasingly moving to beyond the pill solutions, right? with, uh, digital healthcare companies or diagnostic companies. That has become a traditional model for, has become embedded in the traditional thinking of biopharma. So those are some of the things that are already happening and. Also, I would say if you think of, uh, not primary prevention, if you think of secondary and tertiary prevention, pharma has invested traditionally, I mean, I would think [00:23:00] of it differently, has invested traditionally in prevention area, right? So for example, if you think of, early neurogenerative diseases. These are all prevention models, right? Uh, you think of Parkinson's, you think of a ALS, you think of ms, you think of Alzheimer's. These are all prevention models, right? You think of cardiometabolic diseases, right? GLP-1 explosion. These are all preventative therapy, right? If you look at oncology interception, these are all preventive models that Biopharma is investing. So it'll take time. I don't think this is, uh, I don't think this can be completely. Uh, can completely move to a paradigm which says that, you know, biopharma is not investing, uh, heavily in prevention.
Yes, they are where the [00:24:00] ROI is and they're not in certain areas where they could do a better job, but fundamentally the structure has to evolve. Structure of RCT structure of how we demonstrate value has to evolve.
Syam Palakurthy: thank you, Amitabh. But I'd love to Cri, turn this next question over to you. It relates to, Amitabh was just saying and what we were saying earlier around the different systems that the US has versus the rest of the world, where potentially it's less determined by national body or by a specific value body, but individual insurance companies. I'm curious. Cri, do you have any thoughts on what needs to change in terms of the incentives given that you have individual insurance companies in the US that are determining that, that value, um, to make it so that it, it makes more sense. And, you know, like, like, I mean, have said there are, there are drugs that, that we have in the market that are preventive focused.
There have been, uh, areas that, that's happening. What [00:25:00] needs to change in terms of the incentives to, to make that, uh, an even bigger focus.
Cristina Masseria: So, as I was saying, we are investing in prevention. Pharma is investing in prevention, and uh, also we know that the budget orders are interested in particular certain, systems more than others. One area I was mentioning before is really the need to look budget differently. So many of the commercial payers, when they do their budgeting decision in really short term, is one year, two years, maximum, three years, as we were saying.
Often for this preventive medicine, you will see the outcome only in the long term. And this horizon might not be sufficient really to demonstrate the value that, you are giving to a patient or to your population by providing these medicines. And this is why Amitabh, I will say one way is to use alternative [00:26:00] approaches with outcome based agreement or value agreement, but they can span across a longer time horizon than potentially the budget that the payers or the insurance companies are holding. this in the past sometimes is creating some. Miscommunications and, but I think we're all working through this and now a lot of the insurance companies, and they have actually value agreement and outcome based agreement as a objective as well. And so they're really moving forward to use more and more this type of.
Tools to demonstrate the value in particular because as Amitabh was saying, for a lot of these inter medications, the clinical trial is short term, often not even from the clinical trial, we can fully demonstrate the long term value and therefore it's very hard even when we have those pricing discussions to align on those [00:27:00] what is the real value for the medicine? And that is when those outcome agreement are very important. And now there is the beauty, there is data everywhere, right? So the insurance companies, they have their own data. They can look at the data the way the pharma companies can look at the data and we can collaborate together, identify what are the right outcomes, what do we wanna measure.
What is the right time horizon for this measurement and adapt our pricing according to the results that we see over time. but as you can imagine, different, these negotiations are happening across a multitude of insurance companies. So it's very complex. While in Europe, let's say you're doing it maybe just with differential authority, once in the US you have to do it many times and uh, and potentially you have different outcomes. With different insurance companies. So you have different models. So you can imagine [00:28:00] the level of complexity. It's, it's quite elevated and what can happen is potentially in one for one insure you are in the formulary for another one, you're not for one, you are preferred. For another one you're not. Right?
So that is why you see also these differences across insurance in, in access and reimbursement of different medication.
Amitabh Singh: So one more thing. Actually let me stop. This is really near and dear to my heart this issue but, but let me, but let me stop and let Indranil comment.
Indranil Bagchi: Uh, not much more to add my, on my end. I mean, I think the miscellaneous incentives we have talked about the need to capture the right data. We have talked about. I think one specific challenge to the US is because of the fragmented healthcare system, you could be going through the process in a certain plan, but when the benefits accrue, you move to a different plan.
So unless there's portability of insurance within the US, that's [00:29:00] the challenge we run into, which we don't run into in a socialized healthcare systems like France that Cristina was describing. Having said that, every healthcare system has its challenges, but if some sort of portability of insurance can be done within the US that would encourage more preventive behavior.
And then the last thing we didn't talk about is a lot of this also behavioral, right? So. Obesity, substance use, et cetera. I mean, these are behavioral notions that cannot be just fixed by medical intervention. These need to be accompanied by behavioral changes, which also needs to be part of the overall regimen along with medical care and everything else.
So yes, the move towards preventive care is happening, but depending on the type of healthcare system, depending on the type of condition we are talking about, the challenges could be different, but nothing that cannot be addressed going forward. Thank you.
Amitabh Singh: So this is, uh, one concrete idea for you, um, this portability mechanism. Right. is something that we [00:30:00] have to work in us, uh, because of membership churn, and that's really, really the most important thing if we need to evolve towards prevention system. The other piece I would say, which is in the same spirit as Indranil said, is, you know, evolution of Benefit design to value-based insurance design. So if something is high value care, there should be low cost sharing, right? For patient US right now, it's exactly the opposite. If it is specialty care. It's very high cost for the patient. So value-based insurance design. That's the second piece that I would say that is, uh, that could happen. The third one is, I would say there has to be a separation between formulary, a formulary, uh, placement and rebate. So this could be done very easily [00:31:00] done by building transparency around, uh, rebate and spread pricing. Right. So that's the third concrete idea for you. And then the fourth one, I would say. There has to be some sort of preferential as I was saying, or coverage for preventive therapy, which is not currently happening. So those are three or four concrete ideas.
Syam Palakurthy: Yeah, I love, I love the concreteness of it. Um, we, we've been talking a lot about the incentives, how we incentivize Biopharmas, insurance companies, even patients, I'd love to hear if we just take a, a step back and, and if you could tell us, maybe Cri, starting with you, like what do you think are the, the biggest access challenges to patients actually for, for the drugs that have actually been launched? Um, or that, that where the molecule has been developed? What do you think the biggest access challenges are? And I'd love to hear your perspective on how it compares in the US versus outside of the [00:32:00] us.
Cristina Masseria: So often is, um, price, I think engineer talked about these, uh, actual discrepancies between value and the share price that the patients are paying where specialty care are extremely expensive in the US and, but they bring huge value to the patients. And, uh, we know that the level inequalities and capability to pay for the patients are very different and, and although pharma companies are often providing vouchers or supporting the patients to cover some of the cost of these medications. They are really substantial cost and they can decentivize the, the patients from continuing from starting the treatment and or [00:33:00] even from continuing the treatment because we, we are really talking about substantial cost and many families in particular. If you, if you're not. Very well off this, this might be very prohibitive. But the second element is also I think, a full understanding of the benefits of the medication. And, uh, and, and I think that is where the dialogue with the with your physicians and now everything is available online. Sometimes it's an advantage, some is a disadvantage because you read so much and you make your own interpretation of things and uh, uh, and we know what we know.
We don't know what we don't know. And, uh, and not often. We don't know what we don't know. And uh, so I always say that for me, uh. the wealth of information that is out there. It's, uh, it's amazing, but [00:34:00] it's, it's also difficult and to digest and that is very important to, to have those very good conversation with your physicians and the experts and to really understand What can be the advantages and disadvantages of this medication in particular where we think about that potentially are taking a variety of medications and there could be side effects or implication of using multiple medications. You really need to understand and know all the potential adverse events and implication that this can have on your body and on your quality of life. And often we don't. The other element that is important in the clinical trial, not often we collect those endpoints that are relevant for the patients. And uh, we are looking at, um, say for a cancer medication, right, the probability of leaving 3, 4, 5, 6 months more. [00:35:00] What if actually those 3, 4, 5, 6 months more, you spend them in a bathroom? Because you're showing up, right? So. That is not good for the patient. So clearly the patient doesn't have an incentive in taking the medication, but not often, or now we're doing more and more, and even FDA's investing on this. There is a huge now framework to push forward to really collect those endpoints that are relevant to the patients in terms of their quality of life, but also their experience. And, uh, with, uh, the healthcare system and the impact, the disease on their daily life daily routine capability to work to bring their kids to school or to the park. Because this has a huge impact on the probability of taking those medications.
Syam Palakurthy: Yeah, that makes a lot of sense. Thank you.
Syam Palakurthy: And I [00:36:00] want to ask this because it's so, uh, it's so topical right now. We're seeing artificial intelligence being implied to. Lot of different areas at the moment. Uh, maybe Indranil I'll ask you this question, do you have any thoughts on, and, and I'd love to hear from Amitabh and Cri and as well, do you have any thoughts on where can artificial intelligence have an impact on the, you know, the value, access and pricing side and where, where do you think it's just not going to make that much of a difference?
Indranil Bagchi: Thank you, Syam, for the question. Of course, I mean, artificial intelligence is the next big thing that we are all looking for the proof to happen. And, uh, I, I know it's being applied in many different areas. I think the application to healthcare may have been somewhat slower than some of the other industry that we are familiar with.
When it comes to access, where can it help the most? It can help with predictability in the end, drug development and access to medicines. The biggest piece that gets [00:37:00] along the way is uncertainty of science, and that's where AI can step in. And just by simply looking at previous results that have been obtained and digging into those databases and help us plan better clinical trials, making sure the right population is included, making sure the right endpoints are included, and if we do all of that,
what could be the predictability of the results clinically humanistically, economically, and driven by that, what could be the corresponding access. So I think that's where industry as well as the different stakeholders are trying to apply artificial intelligence. And by applying it successfully, if we can take some of the time lag out, so reduce the time to drug development.
As well as take some of the cost out, reduce the cost of drug development, that could be a significant contribution to human society. So I would say yes, if you have to focus on one area, that would be removing uncertainty. And the way we are doing pilots in terms of how we're applying AI is [00:38:00] as we have to respond to the different, you know, assessment agencies, health technology, assessment agencies.
It's just using AI to be able to respond quickly just in time, and thereby reducing the need to engage in meetings and thereby reducing the need to wait and improving time to access to medicines. Yeah.
Amitabh Singh: So two or three points here, uh, in addition to, I think Indranil alluded to use of technology to enhance the. Uh, RCPs, uh, randomized clinical trial. One way we should think about, uh, AI is that it has dramatically reduced the cost of doing, uh, real world evidence, collecting real world evidence data, right? So obviously, what are some of the ways in which real world evidence can be scaled up with the help of ai? not an expert in ai, but that's, uh, one of the opportunity. I [00:39:00] think the second piece where AI can help us is in what I would say, identification of subpopulations, uh, where the patient is more likely to, uh, respond to a particular treatment.
Right. Uh. That actually feeds into how you can better design your clinical studies to demonstrate value, right? if you can identify those subpopulation and if you can recruit based on that, uh. Avoiding the bias that is inherent in that kind of design. If you can do that, that is, uh, really important. And the third piece I would say, and this is getting into the technical, uh, aspects, but AI has, uh, enabled us to now, um, and NICE is using it, uh, [00:40:00] is called dynamic economic model. So your cost effectiveness, uh. Models are continuously updated in real time, on a real time basis. So those are two or three ideas that comes to mind off the top of my head.
The final piece I would say is that can we deploy AI to identify where value-based contracting has worked well in the past, and then learn from that and apply that both in the payer and healthcare system setting as well as for biopharma.
Syam Palakurthy: Great. Thank you. And crew. Any anything you'd want to add to that?
Cristina Masseria: I think Indranil and Amitabh covered most of it. And as Amitabh said, where it's just the beginning. I think for me, 2025 was the boom and uh, everything now is in front of. Us [00:41:00] in 2026 will be the moment where actually we're going to see some of the results also in healthcare. And, uh, because some of those applications now are becoming real and we see the real impact. I think this will be, will be a year, I suppose, full of, um, of those results of using AI and gaining more efficiencies and more predictability as Indranil mentioned, which is key for budgeting.
Syam Palakurthy: Yeah, that makes sense. And, and I know we're, we're gonna have to start wrapping, uh, the conversation. As you might know, we, we have listeners who come from the provider side, from the biopharma side, the payer side, and even some of the, the policy making and regulatory side. love for, for each of you and maybe starting with Amitabh and then Cri and then Indranil. If you just have one piece of advice or one recommendation, and you can, you can direct it to any of those four stakeholders, the provider, biopharma, [00:42:00] uh, the payer or the regulatory side. What, what one piece of advice or ask would you make, um, to, to one of those groups to kind of move this forward so more patients are able to get on the right treatment at the, the right moment in time.
Amitabh Singh: Yeah. Wow. That's a big question. Uh, Sam, uh. I think off the top of my head, what comes to my mind is. This whole concept of fragmentation on the payer side, right? Uh, especially in the US healthcare system. And, uh, we in biopharma are often, um. Complaining that it's too fragmented, too challenging, and it's, it's, it's not possible and it is beyond [00:43:00] repair.
I think what my advice to, you know, leaders like, uh, Cri and uh, and Biopharma is, uh, would be that, you know. Market access in 2026 is no longer about winning every negotiation with PBM. It is about, uh, what I would say managing the trade-offs, right? If PBM says No, put patients to cash. GLP one have demonstrated that employer says, uh, something is too expensive, offer them outcomes based contract. government says, uh, well, it's too high, then manufacturers can accept, uh, MFP in return for. Larger volume. that's what I, I think, I think we [00:44:00] should focus more on what are the tradeoffs and what is feasible within the context of those tradeoffs. Rather than complain about healthcare system and its fragmentation.
Syam Palakurthy: Yeah. I, I love that it's very realistic and, uh, realism driven, but very actionable. Cree, how about you?
Cristina Masseria: So I would, um, ask them to talk more among each other’s and, uh, because at the end of the day, we all share the same objective, which is improving the health of the society. And making sure the right patients gets the right medicine at the right time. Because all of us, wherever we sit, we are patients and or we have patients in our families, right?
So I feel we need to improve the level of trust and collaboration and dialogue. [00:45:00] if we are able to do that, I feel that a lot of those misincentives and fragmentation. Can be resolved. And that is going back to Amitabh, right? We can find a different way of doing things, but we can only do that if we have a very honest and open dialogue where we are listening to each other's needs and we try to find productive and efficient solutions together.
Syam Palakurthy: Yeah.
Indranil Bagchi: And not much more to add on my end, I think we started the conversation with fragmentation of the healthcare system. I would end the conversation and the exact opposite place, which is how can we get to a holistic approach to healthcare? And I think that's what both Cristina and Amitabh alluded to.
Uh, every different stakeholder has a different role to play. They have different needs, they have different skills and capabilities. Which requires us to engage in dialogue, which Cristina has already referred to. [00:46:00] It also requires us to put each other in other shoes and try to understand where they're coming from and what they're bringing to the table.
But in the end, if we can have a more holistic approach to healthcare, make prevention along with treatment, a part of the whole cycle, and in the end, making sure in whether it's. A long-term view, whether it's view across different segments, we have the ultimate patient benefit in mind and drive towards that.
I'm confident we can improve access to medicines and thereby make the world a better place. So putting a plug for holistic healthcare. And thank you for inviting us to this podcast.
Syam Palakurthy: Yeah. Well that, that seems like a really wonderful note to end on. Thank you all for taking the time. I know you're in different time zones, different parts of the world. Uh, so we're, we're thrilled that we could get the three of you in your brains in one place, in one conversation together.
Kip Theno: Yes. Thank you all. And I always end with an Easter egg question, by the way, Sean, thank you for [00:47:00] as usual, masterful. Um, look, we spend 17% of our GDP here and I don't think we're going to solve this overnight 'cause the trouble certainly didn't happen. 24 hours ago, but we'd love to have you back on to talk about access cost prevention, the great debate on PBMs, which is pretty hot topic here right now.
Payer uniformity. So here's my Easter egg question, and again, thank you all for your time. I dunno if you saw the big news, but steak has just been put back at the top of the pyramid in uh, in our dietary plans. I don’t know if you saw that it was moved back to the top and I've got three doctors on up or thumbs down.
I'm personally very pleased with that decision.
Amitabh Singh: How can I put a thumbs down for steaks?
Kip Theno: one, uh, that's a sideways, uh, that's a thumbs down. All right. I ate the final vote. Two to one. Two to two. We tied. Okay. Thank you guys. Hey, again, happy New Year. Appreciate y'all being on the show. Um, 2026 off to a great [00:48:00] start on the Road to Care podcast and, and again, together we can make things right.
Look forward to seeing you again this year. Thank you all.
Indranil Bagchi: Thank you very much.
Cristina Masseria: you.
Amitabh Singh: Thank you.
Syam Palakurthy: Thank you all.
Thank you for joining the Road to Care podcast, hosted by SamaCare, the leader in prior authorization technology and services, where through a script to therapy operating system, we enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced, and recorded by Jamestown.
Podcast produced by JFACTOR, visit https://www.jfactor.com/
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