{"version":"1.0.0","segments":[{"startTime":0.36,"endTime":1.8,"body":"- Hi, welcome."},{"startTime":1.8,"endTime":3.48,"body":"My name is Steve O'Malley."},{"startTime":3.48,"endTime":6.81,"body":"I'll be the moderator today"},{"startTime":3.48,"endTime":6.81,"body":"for our session entitled,"},{"startTime":6.81,"endTime":11.31,"body":"Designing a Global Market"},{"startTime":6.81,"endTime":11.31,"body":"Access Strategy Built for MFN."},{"startTime":11.31,"endTime":12.9,"body":"Today's session is really meant"},{"startTime":12.9,"endTime":15.9,"body":"to give a high level 10,000 foot view"},{"startTime":15.9,"endTime":20.9,"body":"of US and global impact of"},{"startTime":15.9,"endTime":20.9,"body":"MFN, mostly focused on global."},{"startTime":22.11,"endTime":26.13,"body":"How did this strategy come to"},{"startTime":22.11,"endTime":26.13,"body":"be with most favored nation?"},{"startTime":26.13,"endTime":27.99,"body":"What does that look like for implications"},{"startTime":27.99,"endTime":30.84,"body":"for countries around the globe?"},{"startTime":30.84,"endTime":32.19,"body":"We'll be talking a little bit about"},{"startTime":32.19,"endTime":35.61,"body":"how this may impact upcoming"},{"startTime":32.19,"endTime":35.61,"body":"launches for biotech"},{"startTime":35.61,"endTime":38.67,"body":"and mature pharmaceutical companies,"},{"startTime":38.67,"endTime":42.54,"body":"as well as products that"},{"startTime":38.67,"endTime":42.54,"body":"are already in the market."},{"startTime":42.54,"endTime":45.54,"body":"And then, we'll be thinking"},{"startTime":42.54,"endTime":45.54,"body":"through strategic options"},{"startTime":45.54,"endTime":47.22,"body":"for companies through our panellists"},{"startTime":47.22,"endTime":49.02,"body":"that are listed here today."},{"startTime":49.02,"endTime":51.9,"body":"And then lastly, what are the unintended,"},{"startTime":51.9,"endTime":55.83,"body":"or intended complications"},{"startTime":51.9,"endTime":55.83,"body":"of most favored nation."},{"startTime":55.83,"endTime":59.37,"body":"Join here today by our"},{"startTime":55.83,"endTime":59.37,"body":"panellists, Michael Garner,"},{"startTime":59.37,"endTime":61.77,"body":"Catherine Beecher, and Clare Foy,"},{"startTime":61.77,"endTime":65.49,"body":"who will introduce themselves"},{"startTime":61.77,"endTime":65.49,"body":"here in just a second."},{"startTime":65.49,"endTime":69.45,"body":"But I wanted to thank them"},{"startTime":65.49,"endTime":69.45,"body":"and welcome to the discussion"},{"startTime":69.45,"endTime":73.2,"body":"and they'll be driving most"},{"startTime":69.45,"endTime":73.2,"body":"of the discussion today."},{"startTime":73.2,"endTime":77.323,"body":"So, principally, the most"},{"startTime":73.2,"endTime":77.323,"body":"favored nation legislation,"},{"startTime":79.17,"endTime":82.38,"body":"if you will, seems pretty straightforward."},{"startTime":82.38,"endTime":87.03,"body":"How do we reduce drug"},{"startTime":82.38,"endTime":87.03,"body":"prices in the US based off"},{"startTime":87.03,"endTime":89.31,"body":"of referencing other markets?"},{"startTime":89.31,"endTime":91.29,"body":"Seems pretty straightforward."},{"startTime":91.29,"endTime":95.37,"body":"Like most laws, there's"},{"startTime":91.29,"endTime":95.37,"body":"many unintended consequences"},{"startTime":95.37,"endTime":97.23,"body":"when you actually start"},{"startTime":95.37,"endTime":97.23,"body":"thinking through actually"},{"startTime":97.23,"endTime":99.75,"body":"how it's calculated in the transparency"},{"startTime":99.75,"endTime":102.36,"body":"or lack thereof of most favored nation"},{"startTime":102.36,"endTime":104.37,"body":"or actually drug pricing."},{"startTime":104.37,"endTime":106.74,"body":"So, we wanted to actually"},{"startTime":104.37,"endTime":106.74,"body":"chat about that today,"},{"startTime":106.74,"endTime":109.77,"body":"and ultimately, what"},{"startTime":106.74,"endTime":109.77,"body":"pharmaceutical manufacturers"},{"startTime":109.77,"endTime":112.47,"body":"may think about as they"},{"startTime":109.77,"endTime":112.47,"body":"kind of move forward."},{"startTime":112.47,"endTime":115.77,"body":"So, I guess I will start with Michael."},{"startTime":115.77,"endTime":119.07,"body":"Could you really briefly"},{"startTime":115.77,"endTime":119.07,"body":"introduce yourself,"},{"startTime":119.07,"endTime":120.51,"body":"give us a little bit of your background,"},{"startTime":120.51,"endTime":123.63,"body":"and then maybe talk to us"},{"startTime":120.51,"endTime":123.63,"body":"a little bit about GENEROUS"},{"startTime":123.63,"endTime":127.65,"body":"as part of the MFN, and"},{"startTime":123.63,"endTime":127.65,"body":"where you see that heading."},{"startTime":127.65,"endTime":129.3,"body":"- Sure, thank you, Steve."},{"startTime":129.3,"endTime":131.55,"body":"My name is Michael Garner,"},{"startTime":129.3,"endTime":131.55,"body":"I'm the vice president"},{"startTime":131.55,"endTime":135.84,"body":"of Policy and Strategy for Artia Solutions"},{"startTime":135.84,"endTime":138.87,"body":"- Powered by Petauri. And"},{"startTime":135.84,"endTime":138.87,"body":"my background, I've been in"},{"startTime":138.87,"endTime":140.94,"body":"health policy for close to 35 years,"},{"startTime":140.94,"endTime":144.84,"body":"and have primarily been working"},{"startTime":140.94,"endTime":144.84,"body":"in the Medicaid markets,"},{"startTime":144.84,"endTime":147.27,"body":"although I also have experience"},{"startTime":144.84,"endTime":147.27,"body":"in the commercial markets"},{"startTime":147.27,"endTime":148.68,"body":"and Medicare as well."},{"startTime":148.68,"endTime":151.71,"body":"So, been following this"},{"startTime":148.68,"endTime":151.71,"body":"since its very beginning"},{"startTime":151.71,"endTime":154.05,"body":"all the way back to the"},{"startTime":151.71,"endTime":154.05,"body":"first Trump administration,"},{"startTime":154.05,"endTime":156.24,"body":"and have just a lot of information"},{"startTime":156.24,"endTime":158.31,"body":"that I'm really looking forward to share"},{"startTime":158.31,"endTime":160.32,"body":"with the group today."},{"startTime":160.32,"endTime":163.8,"body":"GENEROUS, Steve, you're asking,"},{"startTime":160.32,"endTime":163.8,"body":"where is GENEROUS going?"},{"startTime":163.8,"endTime":166.74,"body":"And that is really the"},{"startTime":163.8,"endTime":166.74,"body":"million dollar question,"},{"startTime":166.74,"endTime":169.92,"body":"because there's so much"},{"startTime":166.74,"endTime":169.92,"body":"uncertainty around it."},{"startTime":169.92,"endTime":172.35,"body":"What we have right now is a model"},{"startTime":172.35,"endTime":174.99,"body":"where manufacturers are having to apply"},{"startTime":174.99,"endTime":178.56,"body":"to the Federal Centres for"},{"startTime":174.99,"endTime":178.56,"body":"Medicaid and Medicare Services,"},{"startTime":178.56,"endTime":182.31,"body":"CMI Centre, to say that"},{"startTime":178.56,"endTime":182.31,"body":"they want to participate."},{"startTime":182.31,"endTime":184.38,"body":"They've got to provide"},{"startTime":182.31,"endTime":184.38,"body":"quite a bit of information"},{"startTime":184.38,"endTime":189.36,"body":"to the federal government"},{"startTime":184.38,"endTime":189.36,"body":"in order to be considered"},{"startTime":189.36,"endTime":191.07,"body":"on whether or not they can join it."},{"startTime":191.07,"endTime":192.42,"body":"And then, they have to ultimately sign"},{"startTime":192.42,"endTime":195.84,"body":"a participation agreement"},{"startTime":192.42,"endTime":195.84,"body":"with the federal government."},{"startTime":195.84,"endTime":198.6,"body":"Then at some point, the"},{"startTime":195.84,"endTime":198.6,"body":"states have to get involved."},{"startTime":198.6,"endTime":200.07,"body":"The states are going to"},{"startTime":198.6,"endTime":200.07,"body":"have to make a decision"},{"startTime":200.07,"endTime":202.38,"body":"on whether or not they want to join."},{"startTime":202.38,"endTime":203.79,"body":"And even when they want to join,"},{"startTime":203.79,"endTime":205.62,"body":"they're going to have to make decision"},{"startTime":205.62,"endTime":208.35,"body":"on which drugs they want to use"},{"startTime":208.35,"endTime":210.27,"body":"as part of their Medicaid programme"},{"startTime":210.27,"endTime":214.356,"body":"that uses the GENEROUS"},{"startTime":210.27,"endTime":214.356,"body":"model MFN priced drugs."},{"startTime":214.356,"endTime":217.71,"body":"So, there's a lot going on out there."},{"startTime":217.71,"endTime":220.44,"body":"We still have not heard exactly"},{"startTime":220.44,"endTime":224.28,"body":"how many manufacturers are"},{"startTime":220.44,"endTime":224.28,"body":"going to ultimately participate."},{"startTime":224.28,"endTime":225.93,"body":"They're supposed to get"},{"startTime":224.28,"endTime":225.93,"body":"their applications in"},{"startTime":225.93,"endTime":228.96,"body":"by the end of this"},{"startTime":225.93,"endTime":228.96,"body":"month, and then they have"},{"startTime":228.96,"endTime":231.45,"body":"to have their participation"},{"startTime":228.96,"endTime":231.45,"body":"agreements done"},{"startTime":231.45,"endTime":233.34,"body":"by the end of June."},{"startTime":233.34,"endTime":235.08,"body":"And then, the states ultimately"},{"startTime":235.08,"endTime":239.79,"body":"have to get their applications"},{"startTime":235.08,"endTime":239.79,"body":"in to participate by July,"},{"startTime":239.79,"endTime":241.35,"body":"and their participation agreements"},{"startTime":241.35,"endTime":244.86,"body":"with the federal government"},{"startTime":241.35,"endTime":244.86,"body":"by the end of August."},{"startTime":244.86,"endTime":246.27,"body":"So, we've got a lot of time here"},{"startTime":246.27,"endTime":249.06,"body":"that we're still looking at,"},{"startTime":246.27,"endTime":249.06,"body":"but it's really closing in"},{"startTime":249.06,"endTime":251.37,"body":"for the manufacturers"},{"startTime":249.06,"endTime":251.37,"body":"at this point to decide"},{"startTime":251.37,"endTime":254.25,"body":"whether or not they are"},{"startTime":251.37,"endTime":254.25,"body":"going to ultimately sit down"},{"startTime":254.25,"endTime":256.83,"body":"and negotiate, and"},{"startTime":254.25,"endTime":256.83,"body":"become part of the model."},{"startTime":256.83,"endTime":258.81,"body":"So, that's kind of a general framework,"},{"startTime":258.81,"endTime":261.57,"body":"but happy to answer any"},{"startTime":258.81,"endTime":261.57,"body":"other questions on that."},{"startTime":261.57,"endTime":262.44,"body":"- Great."},{"startTime":262.44,"endTime":263.88,"body":"I have a tonne of questions for you,"},{"startTime":263.88,"endTime":265.47,"body":"so we'll come back to it in a second,"},{"startTime":265.47,"endTime":268.23,"body":"but I want to introduce our"},{"startTime":265.47,"endTime":268.23,"body":"other panellists as well."},{"startTime":268.23,"endTime":270.48,"body":"Catherine, could you"},{"startTime":268.23,"endTime":270.48,"body":"introduce yourself real quick,"},{"startTime":270.48,"endTime":271.92,"body":"and then maybe talk a little bit"},{"startTime":271.92,"endTime":273.42,"body":"about some of the other programmes"},{"startTime":273.42,"endTime":276.0,"body":"within MFN with GUARD and GLOBE?"},{"startTime":276.0,"endTime":276.833,"body":"- Absolutely."},{"startTime":276.833,"endTime":277.71,"body":"And thank you, Steve."},{"startTime":277.71,"endTime":278.64,"body":"Thank you, Michael."},{"startTime":278.64,"endTime":280.89,"body":"Hi, everyone, I'm Catherine Beecher."},{"startTime":280.89,"endTime":283.83,"body":"I'm a director in the Global Pricing"},{"startTime":283.83,"endTime":286.167,"body":"and Market Access team here at Petauri."},{"startTime":286.167,"endTime":288.45,"body":"And I think Michael's"},{"startTime":286.167,"endTime":288.45,"body":"been extremely modest,"},{"startTime":288.45,"endTime":291.83,"body":"'cause I think he and his"},{"startTime":288.45,"endTime":291.83,"body":"team are supporting companies"},{"startTime":291.83,"endTime":294.93,"body":"at the moment, and we're"},{"startTime":291.83,"endTime":294.93,"body":"working alongside him"},{"startTime":294.93,"endTime":299.37,"body":"to help people assess the ins and outs,"},{"startTime":299.37,"endTime":303.72,"body":"and the intricacies of whether"},{"startTime":299.37,"endTime":303.72,"body":"to submit for generalists."},{"startTime":303.72,"endTime":305.46,"body":"I think that is a really critical thing."},{"startTime":305.46,"endTime":310.35,"body":"And from the global"},{"startTime":305.46,"endTime":310.35,"body":"side, the key piece is,"},{"startTime":310.35,"endTime":312.69,"body":"that they're exploring at net level,"},{"startTime":312.69,"endTime":315.51,"body":"or at least ostensibly being asked"},{"startTime":315.51,"endTime":319.767,"body":"to consider the true net"},{"startTime":315.51,"endTime":319.767,"body":"level in these target markets."},{"startTime":319.767,"endTime":322.173,"body":"And there are eight key"},{"startTime":319.767,"endTime":322.173,"body":"markets for GENEROUS."},{"startTime":323.163,"endTime":325.26,"body":"And so, we are thinking about"},{"startTime":325.26,"endTime":330.197,"body":"how that is going to influence"},{"startTime":325.26,"endTime":330.197,"body":"the prices within the US,"},{"startTime":332.34,"endTime":335.37,"body":"because obviously, for"},{"startTime":332.34,"endTime":335.37,"body":"already marketed products,"},{"startTime":335.37,"endTime":336.72,"body":"which is obviously what we're focusing"},{"startTime":336.72,"endTime":341.58,"body":"on primarily right now,"},{"startTime":336.72,"endTime":341.58,"body":"there is a limited ability,"},{"startTime":341.58,"endTime":346.58,"body":"I would say, to make adjustments, ex-US."},{"startTime":348.6,"endTime":352.53,"body":"I think obviously there are"},{"startTime":348.6,"endTime":352.53,"body":"some notable exceptions to that."},{"startTime":352.53,"endTime":355.71,"body":"I think we are seeing"},{"startTime":352.53,"endTime":355.71,"body":"some public announcements"},{"startTime":355.71,"endTime":358.77,"body":"around perhaps some price"},{"startTime":355.71,"endTime":358.77,"body":"increases for certain products"},{"startTime":358.77,"endTime":363.54,"body":"where that is possible, maybe"},{"startTime":358.77,"endTime":363.54,"body":"more in the private sector."},{"startTime":363.54,"endTime":367.68,"body":"We're also seeing some"},{"startTime":363.54,"endTime":367.68,"body":"withdrawals as well,"},{"startTime":367.68,"endTime":370.05,"body":"obviously companies"},{"startTime":367.68,"endTime":370.05,"body":"taking a decision to try,"},{"startTime":370.05,"endTime":375.05,"body":"and eliminate risk for"},{"startTime":370.05,"endTime":375.05,"body":"smaller, lower price markets,"},{"startTime":375.51,"endTime":378.003,"body":"and kind of narrow that global corridor."},{"startTime":381.0,"endTime":384.033,"body":"But ultimately, for"},{"startTime":381.0,"endTime":384.033,"body":"the in-market products,"},{"startTime":384.93,"endTime":387.54,"body":"there is going to be an"},{"startTime":384.93,"endTime":387.54,"body":"adjustment in the US price,"},{"startTime":387.54,"endTime":390.6,"body":"'cause we are still"},{"startTime":387.54,"endTime":390.6,"body":"seeing a big differential,"},{"startTime":390.6,"endTime":392.52,"body":"are we not, Michael,"},{"startTime":392.52,"endTime":395.13,"body":"even including all the"},{"startTime":392.52,"endTime":395.13,"body":"rebating that's going on."},{"startTime":395.13,"endTime":397.92,"body":"These incremental rebates"},{"startTime":395.13,"endTime":397.92,"body":"would need to be applied"},{"startTime":397.92,"endTime":402.92,"body":"to get down to ex-manufacturer"},{"startTime":397.92,"endTime":402.92,"body":"levels in the ex-US markets."},{"startTime":405.99,"endTime":408.96,"body":"- Yeah, and Cathy,"},{"startTime":405.99,"endTime":408.96,"body":"actually, and really again,"},{"startTime":408.96,"endTime":411.96,"body":"when we start looking at states"},{"startTime":408.96,"endTime":411.96,"body":"and how they're going to react,"},{"startTime":411.96,"endTime":416.4,"body":"and also the PBMs and some"},{"startTime":411.96,"endTime":416.4,"body":"of the purchasing pools"},{"startTime":416.4,"endTime":418.89,"body":"and how they're going to act,"},{"startTime":416.4,"endTime":418.89,"body":"there's a real big question"},{"startTime":418.89,"endTime":421.35,"body":"about is MFN going to ultimately,"},{"startTime":421.35,"endTime":424.8,"body":"what roles they going to play,"},{"startTime":421.35,"endTime":424.8,"body":"are states going to sit there?"},{"startTime":424.8,"endTime":427.41,"body":"Is there an incentive for"},{"startTime":424.8,"endTime":427.41,"body":"states to actually say,"},{"startTime":427.41,"endTime":429.42,"body":"now that I know what the MFN price is,"},{"startTime":429.42,"endTime":431.49,"body":"I'm going to talk to the"},{"startTime":429.42,"endTime":431.49,"body":"manufacturer separately,"},{"startTime":431.49,"endTime":434.19,"body":"and say, can you do better?"},{"startTime":434.19,"endTime":436.47,"body":"You had consortium PBMs,"},{"startTime":436.47,"endTime":439.68,"body":"they're going to have to say,"},{"startTime":436.47,"endTime":439.68,"body":"we got to keep adding value."},{"startTime":439.68,"endTime":442.68,"body":"Are they going to come back and"},{"startTime":439.68,"endTime":442.68,"body":"say, we know what the MFN is?"},{"startTime":442.68,"endTime":444.84,"body":"And so, manufacturers, we want you."},{"startTime":444.84,"endTime":446.67,"body":"So, that uncertainty that"},{"startTime":444.84,"endTime":446.67,"body":"you're talking about,"},{"startTime":446.67,"endTime":449.34,"body":"where's that bottom price"},{"startTime":446.67,"endTime":449.34,"body":"going to ultimately be"},{"startTime":449.34,"endTime":452.31,"body":"is a real question mark that"},{"startTime":449.34,"endTime":452.31,"body":"we're all trying to figure out."},{"startTime":452.31,"endTime":454.77,"body":"- Yeah, and I think"},{"startTime":452.31,"endTime":454.77,"body":"that the key is as well"},{"startTime":454.77,"endTime":457.95,"body":"for GENEROUS, obviously, as"},{"startTime":454.77,"endTime":457.95,"body":"you've said, it's voluntary."},{"startTime":457.95,"endTime":462.72,"body":"I mean, the other models or sort of models"},{"startTime":462.72,"endTime":465.24,"body":"that are being explored"},{"startTime":462.72,"endTime":465.24,"body":"for GLOBE and GUARD,"},{"startTime":465.24,"endTime":467.04,"body":"which is obviously the other pieces"},{"startTime":467.04,"endTime":469.05,"body":"that are not yet in motion,"},{"startTime":469.05,"endTime":472.02,"body":"be it, they were under"},{"startTime":469.05,"endTime":472.02,"body":"consultation as I understand it."},{"startTime":472.02,"endTime":474.27,"body":"And we did check before coming online"},{"startTime":474.27,"endTime":477.72,"body":"to see if anything else had"},{"startTime":474.27,"endTime":477.72,"body":"come into the public domain."},{"startTime":477.72,"endTime":480.42,"body":"We're waiting to see how"},{"startTime":477.72,"endTime":480.42,"body":"that's all going to evolve,"},{"startTime":480.42,"endTime":483.48,"body":"but GLOBE and GUARD are"},{"startTime":480.42,"endTime":483.48,"body":"kind of similar types"},{"startTime":483.48,"endTime":488.48,"body":"of assessment models looking"},{"startTime":483.48,"endTime":488.48,"body":"at Medicare Part B and Part D."},{"startTime":490.2,"endTime":493.68,"body":"And there's some criteria"},{"startTime":490.2,"endTime":493.68,"body":"around therapy areas,"},{"startTime":493.68,"endTime":498.33,"body":"and certain revenue thresholds that apply."},{"startTime":498.33,"endTime":500.16,"body":"But the key thing there is that,"},{"startTime":500.16,"endTime":504.03,"body":"it's proposed to be a mandatory model."},{"startTime":504.03,"endTime":506.88,"body":"So, there's no choice about"},{"startTime":504.03,"endTime":506.88,"body":"whether to participate."},{"startTime":506.88,"endTime":511.17,"body":"And again, we're looking at"},{"startTime":506.88,"endTime":511.17,"body":"that kind of true net price."},{"startTime":511.17,"endTime":515.34,"body":"It's a broader basket of markets"},{"startTime":511.17,"endTime":515.34,"body":"that are being considered."},{"startTime":515.34,"endTime":517.8,"body":"I mean, we didn't flag specifically,"},{"startTime":517.8,"endTime":520.05,"body":"but I'm sure everyone is"},{"startTime":517.8,"endTime":520.05,"body":"aware that for GENEROUS,"},{"startTime":520.05,"endTime":523.02,"body":"it's kind of key EU markets,"},{"startTime":523.02,"endTime":528.02,"body":"Japan, Denmark, Switzerland, Canada,"},{"startTime":528.99,"endTime":531.36,"body":"and then obviously, for GLOBE and GUARD,"},{"startTime":531.36,"endTime":532.47,"body":"it's a broader basket,"},{"startTime":532.47,"endTime":535.35,"body":"which includes a much wider"},{"startTime":532.47,"endTime":535.35,"body":"range of European markets"},{"startTime":535.35,"endTime":539.28,"body":"and some additional Asian"},{"startTime":535.35,"endTime":539.28,"body":"markets and Australia."},{"startTime":539.28,"endTime":542.16,"body":"I think the key as well is"},{"startTime":539.28,"endTime":542.16,"body":"that for GLOBE and GUARD,"},{"startTime":542.16,"endTime":547.097,"body":"it's looking at the lowest"},{"startTime":542.16,"endTime":547.097,"body":"price, albeit with some uplift."},{"startTime":548.43,"endTime":550.41,"body":"I think if you choose to engage"},{"startTime":550.41,"endTime":553.8,"body":"and provide the ex-factory"},{"startTime":550.41,"endTime":553.8,"body":"net levels yourself,"},{"startTime":553.8,"endTime":556.35,"body":"there's a kind of an uplift."},{"startTime":556.35,"endTime":560.43,"body":"And if not, the idea is that CMS"},{"startTime":560.43,"endTime":562.86,"body":"would estimate that for you."},{"startTime":562.86,"endTime":567.24,"body":"I think the key here is in"},{"startTime":562.86,"endTime":567.24,"body":"both model, or three models,"},{"startTime":567.24,"endTime":569.55,"body":"there's the idea that there"},{"startTime":567.24,"endTime":569.55,"body":"should be some adjustment"},{"startTime":569.55,"endTime":571.62,"body":"with PPP adjustment."},{"startTime":571.62,"endTime":574.647,"body":"So, trying to allow for different GDPs"},{"startTime":574.647,"endTime":575.48,"body":"and that kind of thing."},{"startTime":575.48,"endTime":577.68,"body":"And actually, we've been"},{"startTime":575.48,"endTime":577.68,"body":"doing that assessment,"},{"startTime":577.68,"endTime":580.2,"body":"and it's interesting what comes out"},{"startTime":580.2,"endTime":583.14,"body":"as the second lowest price for GENEROUS,"},{"startTime":583.14,"endTime":585.63,"body":"or the lowest when you actually"},{"startTime":583.14,"endTime":585.63,"body":"make those adjustments."},{"startTime":585.63,"endTime":588.84,"body":"But it isn't a simple"},{"startTime":585.63,"endTime":588.84,"body":"or straightforward task"},{"startTime":588.84,"endTime":590.61,"body":"to actually assess those prices."},{"startTime":590.61,"endTime":591.78,"body":"You would think it would be,"},{"startTime":591.78,"endTime":593.46,"body":"but actually in reality"},{"startTime":593.46,"endTime":596.46,"body":"when we're working with"},{"startTime":593.46,"endTime":596.46,"body":"companies, it's not."},{"startTime":596.46,"endTime":599.67,"body":"So, I think that's an"},{"startTime":596.46,"endTime":599.67,"body":"interesting learning on my side,"},{"startTime":599.67,"endTime":602.91,"body":"but we'll see whether that"},{"startTime":599.67,"endTime":602.91,"body":"actually comes into being."},{"startTime":602.91,"endTime":605.46,"body":"- Perfect, thank you,"},{"startTime":602.91,"endTime":605.46,"body":"Cathy, very insightful."},{"startTime":605.46,"endTime":606.293,"body":"Clare."},{"startTime":606.293,"endTime":607.8,"body":"Last but certainly not least,"},{"startTime":607.8,"endTime":610.2,"body":"if you would just introduce"},{"startTime":607.8,"endTime":610.2,"body":"yourself really quickly,"},{"startTime":610.2,"endTime":612.63,"body":"and then on the back end of that,"},{"startTime":612.63,"endTime":614.34,"body":"what are you thinking about,"},{"startTime":614.34,"endTime":615.84,"body":"what are companies thinking about,"},{"startTime":615.84,"endTime":619.143,"body":"about how this will impact"},{"startTime":615.84,"endTime":619.143,"body":"global pharmaceutical pricing?"},{"startTime":620.778,"endTime":621.611,"body":"- Sure."},{"startTime":621.611,"endTime":623.55,"body":"Thank you for the introduction,"},{"startTime":623.55,"endTime":626.67,"body":"and thanks to everyone who's joined today."},{"startTime":626.67,"endTime":629.88,"body":"I'm Clare Foy, I'm a"},{"startTime":626.67,"endTime":629.88,"body":"director here at Petauri,"},{"startTime":629.88,"endTime":633.69,"body":"and I head at the Global"},{"startTime":629.88,"endTime":633.69,"body":"Value Pricing and Access team."},{"startTime":633.69,"endTime":636.44,"body":"So, yeah, just to add to"},{"startTime":633.69,"endTime":636.44,"body":"what my colleagues have said,"},{"startTime":636.44,"endTime":641.01,"body":"we're thinking about what"},{"startTime":636.44,"endTime":641.01,"body":"will happen to global prices"},{"startTime":641.01,"endTime":643.11,"body":"as a result of MFN."},{"startTime":643.11,"endTime":644.19,"body":"Obviously, as we've heard,"},{"startTime":644.19,"endTime":647.64,"body":"the intention is to lower federal"},{"startTime":644.19,"endTime":647.64,"body":"drug prices within the US,"},{"startTime":647.64,"endTime":650.64,"body":"but we think this is"},{"startTime":647.64,"endTime":650.64,"body":"likely to have an impact"},{"startTime":650.64,"endTime":652.68,"body":"on pharma pricing worldwide."},{"startTime":652.68,"endTime":654.03,"body":"It's like a domino effect,"},{"startTime":654.03,"endTime":656.34,"body":"you can't just change"},{"startTime":654.03,"endTime":656.34,"body":"one thing in isolation,"},{"startTime":656.34,"endTime":658.77,"body":"it's going to have a"},{"startTime":656.34,"endTime":658.77,"body":"series of knock on effect."},{"startTime":658.77,"endTime":662.88,"body":"So, we've tried to think"},{"startTime":658.77,"endTime":662.88,"body":"about what those might be."},{"startTime":662.88,"endTime":666.06,"body":"Obviously, there's lots of considerations"},{"startTime":666.06,"endTime":667.74,"body":"to bring into account here."},{"startTime":667.74,"endTime":672.09,"body":"So, with GENEROUS as we've said,"},{"startTime":672.09,"endTime":674.88,"body":"there's a requirement for"},{"startTime":672.09,"endTime":674.88,"body":"net price transparency."},{"startTime":674.88,"endTime":677.97,"body":"So, if manufacturers do take part in that,"},{"startTime":677.97,"endTime":681.27,"body":"it could lead to downward"},{"startTime":677.97,"endTime":681.27,"body":"pricing pressure,"},{"startTime":681.27,"endTime":683.64,"body":"and that might ultimately lead to a degree"},{"startTime":683.64,"endTime":687.573,"body":"of global price convergence"},{"startTime":683.64,"endTime":687.573,"body":"where US prices are coming down."},{"startTime":689.01,"endTime":691.74,"body":"As Michael and Cathy said,"},{"startTime":689.01,"endTime":691.74,"body":"maybe commercial prices too,"},{"startTime":691.74,"endTime":693.84,"body":"not just the federal prices."},{"startTime":693.84,"endTime":697.35,"body":"And potentially, some loss"},{"startTime":693.84,"endTime":697.35,"body":"of confidential discounting"},{"startTime":697.35,"endTime":700.083,"body":"because net prices are being disclosed."},{"startTime":701.25,"endTime":703.11,"body":"However, there is a bit of uncertainty"},{"startTime":703.11,"endTime":705.3,"body":"about how this is going to play out"},{"startTime":705.3,"endTime":708.42,"body":"in the medium to long"},{"startTime":705.3,"endTime":708.42,"body":"term, and the effect,"},{"startTime":708.42,"endTime":710.64,"body":"it might be less than first thought"},{"startTime":710.64,"endTime":713.64,"body":"as referring back to the domino effect."},{"startTime":713.64,"endTime":716.91,"body":"There's lots of other"},{"startTime":713.64,"endTime":716.91,"body":"things that might happen"},{"startTime":716.91,"endTime":719.34,"body":"that means it's not quite as"},{"startTime":716.91,"endTime":719.34,"body":"straightforward as just saying,"},{"startTime":719.34,"endTime":721.56,"body":"oh, well, prices are going to come down."},{"startTime":721.56,"endTime":723.84,"body":"So, one thing we wanted"},{"startTime":721.56,"endTime":723.84,"body":"to think about here"},{"startTime":723.84,"endTime":727.74,"body":"is the importance, the strategic"},{"startTime":723.84,"endTime":727.74,"body":"importance of the US market"},{"startTime":727.74,"endTime":729.72,"body":"to pharma companies."},{"startTime":729.72,"endTime":732.05,"body":"It's been cited that about 40%"},{"startTime":732.05,"endTime":734.767,"body":"of global pharmaceutical"},{"startTime":732.05,"endTime":734.767,"body":"revenue is generated in the US,"},{"startTime":734.767,"endTime":737.1,"body":"so it's a very important market."},{"startTime":737.1,"endTime":739.32,"body":"And that means that companies are going"},{"startTime":739.32,"endTime":741.51,"body":"to be thinking very carefully about"},{"startTime":741.51,"endTime":744.21,"body":"how to change their strategies."},{"startTime":744.21,"endTime":748.11,"body":"For example, as Cathy"},{"startTime":744.21,"endTime":748.11,"body":"said, GENEROUS is optional,"},{"startTime":748.11,"endTime":750.96,"body":"so companies may decline to take part,"},{"startTime":750.96,"endTime":753.12,"body":"they might decide not to share"},{"startTime":753.12,"endTime":756.84,"body":"the confidential prices"},{"startTime":753.12,"endTime":756.84,"body":"required for GLOBE and GUARD."},{"startTime":756.84,"endTime":758.22,"body":"There is an alternative route"},{"startTime":758.22,"endTime":761.58,"body":"where those would be calculated"},{"startTime":761.58,"endTime":764.16,"body":"without companies disclosing those."},{"startTime":764.16,"endTime":766.5,"body":"They might not even be"},{"startTime":764.16,"endTime":766.5,"body":"able to share those prices,"},{"startTime":766.5,"endTime":768.51,"body":"as Cathy alluded to,"},{"startTime":768.51,"endTime":772.38,"body":"it's much more complex"},{"startTime":768.51,"endTime":772.38,"body":"than you might think."},{"startTime":772.38,"endTime":774.18,"body":"They may not know the prices"},{"startTime":774.18,"endTime":776.46,"body":"and there may even be some reasons"},{"startTime":776.46,"endTime":781.05,"body":"why they cannot be shared"},{"startTime":776.46,"endTime":781.05,"body":"due to confidentiality."},{"startTime":781.05,"endTime":782.85,"body":"So, we'll think about that a bit more,"},{"startTime":782.85,"endTime":785.25,"body":"I'm sure later on in this webinar."},{"startTime":785.25,"endTime":789.51,"body":"So, to answer the question,"},{"startTime":785.25,"endTime":789.51,"body":"Steve, that you posed,"},{"startTime":789.51,"endTime":792.81,"body":"we do expect to see lower US net prices"},{"startTime":792.81,"endTime":796.32,"body":"for some in market products,"},{"startTime":792.81,"endTime":796.32,"body":"at least to start with."},{"startTime":796.32,"endTime":798.69,"body":"But in the longer term, we think companies"},{"startTime":798.69,"endTime":802.47,"body":"will probably explore ways"},{"startTime":798.69,"endTime":802.47,"body":"to raise ex-US prices,"},{"startTime":802.47,"endTime":805.59,"body":"or at least utilise some mechanisms"},{"startTime":805.59,"endTime":808.353,"body":"to protect the net price"},{"startTime":805.59,"endTime":808.353,"body":"as much as possible."},{"startTime":809.34,"endTime":812.46,"body":"They may also, of course,"},{"startTime":809.34,"endTime":812.46,"body":"delay launching outside the US,"},{"startTime":812.46,"endTime":817.46,"body":"so MFN as it's currently been"},{"startTime":812.46,"endTime":817.46,"body":"moted to be might not apply,"},{"startTime":820.68,"endTime":823.623,"body":"or they might not launch"},{"startTime":820.68,"endTime":823.623,"body":"at all outside the US."},{"startTime":824.46,"endTime":829.2,"body":"And those things would of course"},{"startTime":824.46,"endTime":829.2,"body":"avoid any price referencing"},{"startTime":829.2,"endTime":830.46,"body":"as part of MFN."},{"startTime":830.46,"endTime":832.86,"body":"So, lots of things to think about"},{"startTime":832.86,"endTime":835.56,"body":"and we can explore all of"},{"startTime":832.86,"endTime":835.56,"body":"this during the webinar,"},{"startTime":835.56,"endTime":837.72,"body":"but those are some initial thoughts."},{"startTime":837.72,"endTime":840.09,"body":"- Yeah, and just to build on"},{"startTime":837.72,"endTime":840.09,"body":"what you said there, Clare,"},{"startTime":840.09,"endTime":842.76,"body":"I mean, I think there's"},{"startTime":840.09,"endTime":842.76,"body":"been some reports recently"},{"startTime":842.76,"endTime":845.19,"body":"that actually have analysed,"},{"startTime":842.76,"endTime":845.19,"body":"there's been a number of,"},{"startTime":845.19,"endTime":850.17,"body":"you know, a slowing perhaps"},{"startTime":845.19,"endTime":850.17,"body":"of rollout of ex-US launches"},{"startTime":850.17,"endTime":852.99,"body":"over this period where the"},{"startTime":850.17,"endTime":852.99,"body":"announcement has been made,"},{"startTime":852.99,"endTime":854.67,"body":"and everyone's been watching and waiting"},{"startTime":854.67,"endTime":856.5,"body":"to try and understand what does it mean."},{"startTime":856.5,"endTime":861.06,"body":"Like you say, you want MFN"},{"startTime":856.5,"endTime":861.06,"body":"pricing, how, why, where,"},{"startTime":861.06,"endTime":865.29,"body":"and then as we see more information"},{"startTime":861.06,"endTime":865.29,"body":"with the bilateral deals"},{"startTime":865.29,"endTime":867.45,"body":"and then these models being rolled out,"},{"startTime":867.45,"endTime":870.72,"body":"I think some companies who"},{"startTime":867.45,"endTime":870.72,"body":"are caught in the cross hairs"},{"startTime":870.72,"endTime":874.08,"body":"as it were, really are holding back"},{"startTime":874.08,"endTime":876.93,"body":"and waiting to see how things fall."},{"startTime":876.93,"endTime":881.22,"body":"So, there's been a reduction I"},{"startTime":876.93,"endTime":881.22,"body":"think in a number of typical,"},{"startTime":881.22,"endTime":886.2,"body":"continuation of global"},{"startTime":881.22,"endTime":886.2,"body":"launch in recent times."},{"startTime":886.2,"endTime":888.75,"body":"And hopefully, that will stop"},{"startTime":888.75,"endTime":890.46,"body":"when people get a bit more clarity."},{"startTime":890.46,"endTime":893.19,"body":"But I think it is, as you"},{"startTime":890.46,"endTime":893.19,"body":"say, Clare, a very great risk."},{"startTime":893.19,"endTime":895.47,"body":"I mean, people are going to do the maths,"},{"startTime":895.47,"endTime":897.21,"body":"they're going to do the trade off analysis"},{"startTime":897.21,"endTime":901.68,"body":"and work out what is"},{"startTime":897.21,"endTime":901.68,"body":"the least worst option."},{"startTime":901.68,"endTime":904.95,"body":"And it could be that some"},{"startTime":901.68,"endTime":904.95,"body":"smaller markets are going"},{"startTime":904.95,"endTime":908.07,"body":"to be in a very challenging situation."},{"startTime":908.07,"endTime":911.61,"body":"Hopefully, industry can"},{"startTime":908.07,"endTime":911.61,"body":"find a way to be creative"},{"startTime":911.61,"endTime":914.43,"body":"to ensure that patients"},{"startTime":911.61,"endTime":914.43,"body":"get access to the products"},{"startTime":914.43,"endTime":916.29,"body":"that they need in ex-US markets."},{"startTime":916.29,"endTime":919.26,"body":"We don't want this seemingly sensible idea"},{"startTime":919.26,"endTime":921.06,"body":"that there should be alignment on price,"},{"startTime":921.06,"endTime":925.92,"body":"but it shouldn't prevent"},{"startTime":921.06,"endTime":925.92,"body":"access to patients in need."},{"startTime":925.92,"endTime":929.4,"body":"So, I think that's our role"},{"startTime":925.92,"endTime":929.4,"body":"in supporting companies"},{"startTime":929.4,"endTime":931.74,"body":"to find solutions."},{"startTime":931.74,"endTime":935.22,"body":"- Yeah, as we talked about"},{"startTime":931.74,"endTime":935.22,"body":"before, Cathy and Clare,"},{"startTime":935.22,"endTime":936.273,"body":"great comments."},{"startTime":937.83,"endTime":939.3,"body":"When they roll these programmes out,"},{"startTime":939.3,"endTime":941.7,"body":"there's just so many"},{"startTime":939.3,"endTime":941.7,"body":"unintended consequences"},{"startTime":941.7,"endTime":945.21,"body":"as there was with Medicare"},{"startTime":941.7,"endTime":945.21,"body":"Part D back in the day."},{"startTime":945.21,"endTime":948.57,"body":"It actually created grandfathering"},{"startTime":945.21,"endTime":948.57,"body":"for so many products"},{"startTime":948.57,"endTime":951.21,"body":"that it made it quite"},{"startTime":948.57,"endTime":951.21,"body":"challenging for new products"},{"startTime":951.21,"endTime":953.67,"body":"to figure out how to get"},{"startTime":951.21,"endTime":953.67,"body":"onto the part D formulary."},{"startTime":953.67,"endTime":956.46,"body":"And in some cases, it would"},{"startTime":953.67,"endTime":956.46,"body":"take an additional 18 months"},{"startTime":956.46,"endTime":958.5,"body":"to find good coverage."},{"startTime":958.5,"endTime":960.99,"body":"And Michael, maybe I'll"},{"startTime":958.5,"endTime":960.99,"body":"bring it back to you,"},{"startTime":960.99,"endTime":962.34,"body":"maybe a basic question."},{"startTime":962.34,"endTime":965.67,"body":"How is MFN allegedly calculated"},{"startTime":965.67,"endTime":968.01,"body":"if we can't see all the price?"},{"startTime":968.01,"endTime":969.153,"body":"And then secondly,"},{"startTime":970.623,"endTime":973.14,"body":"what does the pricing look like"},{"startTime":970.623,"endTime":973.14,"body":"within the Medicaid programme?"},{"startTime":973.14,"endTime":975.36,"body":"Maybe just to give a global reference"},{"startTime":975.36,"endTime":979.56,"body":"of where those prices sit today."},{"startTime":979.56,"endTime":981.87,"body":"- Sure, so let me start with"},{"startTime":979.56,"endTime":981.87,"body":"the second part of that."},{"startTime":981.87,"endTime":983.883,"body":"So, we tend to see a average,"},{"startTime":986.16,"endTime":988.17,"body":"once we put together both the federal"},{"startTime":988.17,"endTime":991.59,"body":"and individual state rebates,"},{"startTime":988.17,"endTime":991.59,"body":"and ultimate agreements,"},{"startTime":991.59,"endTime":996.59,"body":"we're tend to see discounts, 75, 80%"},{"startTime":996.6,"endTime":1000.86,"body":"is very common on average"},{"startTime":996.6,"endTime":1000.86,"body":"to get to that level."},{"startTime":1000.86,"endTime":1004.49,"body":"And so, as we look at the MFN pricing,"},{"startTime":1004.49,"endTime":1006.62,"body":"the biggest challenge is, again,"},{"startTime":1006.62,"endTime":1009.35,"body":"which drugs are going"},{"startTime":1006.62,"endTime":1009.35,"body":"to ultimately be offered"},{"startTime":1009.35,"endTime":1010.52,"body":"by the manufacturer,"},{"startTime":1010.52,"endTime":1014.15,"body":"and are they offering it in"},{"startTime":1010.52,"endTime":1014.15,"body":"all the various countries?"},{"startTime":1014.15,"endTime":1017.24,"body":"I mean, a lot of manufacturers"},{"startTime":1017.24,"endTime":1019.97,"body":"that have run into a situation"},{"startTime":1017.24,"endTime":1019.97,"body":"where they only may operate"},{"startTime":1019.97,"endTime":1024.83,"body":"in a single one of the"},{"startTime":1019.97,"endTime":1024.83,"body":"targeted reference countries."},{"startTime":1024.83,"endTime":1027.56,"body":"So, what's the second lowest MFN pricing"},{"startTime":1027.56,"endTime":1030.113,"body":"if they're only in one country?"},{"startTime":1033.444,"endTime":1036.233,"body":"How CMS is going to really"},{"startTime":1033.444,"endTime":1036.233,"body":"get to that MFN pricing,"},{"startTime":1039.222,"endTime":1040.343,"body":"it's still vague."},{"startTime":1041.27,"endTime":1043.88,"body":"It seems like it'd be a"},{"startTime":1041.27,"endTime":1043.88,"body":"straightforward calculation,"},{"startTime":1043.88,"endTime":1044.75,"body":"but it's just not."},{"startTime":1044.75,"endTime":1046.4,"body":"And I really have to circle back"},{"startTime":1046.4,"endTime":1049.94,"body":"on what both Cathy and Clare"},{"startTime":1046.4,"endTime":1049.94,"body":"have mentioned as well."},{"startTime":1049.94,"endTime":1052.22,"body":"And that is, we don't"},{"startTime":1049.94,"endTime":1052.22,"body":"know that manufacturers"},{"startTime":1052.22,"endTime":1055.43,"body":"are going to be able to provide"},{"startTime":1052.22,"endTime":1055.43,"body":"some of the information."},{"startTime":1055.43,"endTime":1057.5,"body":"And so, I think when you"},{"startTime":1055.43,"endTime":1057.5,"body":"put all that together,"},{"startTime":1057.5,"endTime":1060.41,"body":"how MFN is ultimately"},{"startTime":1057.5,"endTime":1060.41,"body":"going to be calculated"},{"startTime":1060.41,"endTime":1063.602,"body":"is still a question mark,"},{"startTime":1063.602,"endTime":1065.873,"body":"and again, we'll continue to watch."},{"startTime":1067.34,"endTime":1070.76,"body":"And I still really firmly"},{"startTime":1067.34,"endTime":1070.76,"body":"believe that there is,"},{"startTime":1070.76,"endTime":1072.2,"body":"again, you were talking, Steve,"},{"startTime":1072.2,"endTime":1077.2,"body":"about some of the disincentives"},{"startTime":1072.2,"endTime":1077.2,"body":"that sometimes are created"},{"startTime":1078.44,"endTime":1081.86,"body":"by this or rather unintended consequences."},{"startTime":1081.86,"endTime":1084.68,"body":"And one of those is that"},{"startTime":1081.86,"endTime":1084.68,"body":"I really still believe"},{"startTime":1084.68,"endTime":1088.49,"body":"that there's a strong incentive for states"},{"startTime":1088.49,"endTime":1092.36,"body":"to really come back if they"},{"startTime":1088.49,"endTime":1092.36,"body":"find out what that MFN price is,"},{"startTime":1092.36,"endTime":1094.55,"body":"and to separately"},{"startTime":1092.36,"endTime":1094.55,"body":"pressure the manufacturers"},{"startTime":1094.55,"endTime":1096.77,"body":"to even go lower below that."},{"startTime":1096.77,"endTime":1100.01,"body":"And so, where we end up is"},{"startTime":1096.77,"endTime":1100.01,"body":"just a big question mark"},{"startTime":1100.01,"endTime":1101.57,"body":"at this point."},{"startTime":1101.57,"endTime":1102.59,"body":"- Perfect, thank you."},{"startTime":1102.59,"endTime":1107.03,"body":"And maybe I'll ask Cathy"},{"startTime":1102.59,"endTime":1107.03,"body":"and Clare the same question"},{"startTime":1107.03,"endTime":1108.29,"body":"but in slightly different ways."},{"startTime":1108.29,"endTime":1112.4,"body":"So, how does this actually"},{"startTime":1108.29,"endTime":1112.4,"body":"impact, Cathy, for you,"},{"startTime":1112.4,"endTime":1114.8,"body":"products that are already launched,"},{"startTime":1114.8,"endTime":1116.78,"body":"and then, Clare, how do you think about it"},{"startTime":1116.78,"endTime":1119.123,"body":"from drugs that are about to launch?"},{"startTime":1121.07,"endTime":1124.58,"body":"- Yeah, so I think products"},{"startTime":1121.07,"endTime":1124.58,"body":"that are already launched,"},{"startTime":1124.58,"endTime":1129.58,"body":"and I think both sort of topics,"},{"startTime":1124.58,"endTime":1129.58,"body":"it depends on who you are."},{"startTime":1132.08,"endTime":1134.15,"body":"Are you a big manufacturer"},{"startTime":1132.08,"endTime":1134.15,"body":"that's already agreed"},{"startTime":1134.15,"endTime":1136.37,"body":"that you're going to participate"},{"startTime":1134.15,"endTime":1136.37,"body":"in this kind of approach,"},{"startTime":1136.37,"endTime":1139.757,"body":"or have you already"},{"startTime":1136.37,"endTime":1139.757,"body":"made nominal reductions"},{"startTime":1141.62,"endTime":1144.89,"body":"in prices in the market?"},{"startTime":1144.89,"endTime":1146.48,"body":"I do think that there,"},{"startTime":1146.48,"endTime":1150.71,"body":"it's unlikely that in the"},{"startTime":1146.48,"endTime":1150.71,"body":"general run of things,"},{"startTime":1150.71,"endTime":1154.07,"body":"people are going to be able"},{"startTime":1150.71,"endTime":1154.07,"body":"to make adjustments ex-US"},{"startTime":1154.07,"endTime":1157.1,"body":"to narrow that corridor significantly."},{"startTime":1157.1,"endTime":1160.615,"body":"You can't increase the"},{"startTime":1157.1,"endTime":1160.615,"body":"prices in most ex-US prices"},{"startTime":1160.615,"endTime":1164.423,"body":"in general, I gave an"},{"startTime":1160.615,"endTime":1164.423,"body":"exception or two earlier."},{"startTime":1165.56,"endTime":1170.56,"body":"And I think, even if we think"},{"startTime":1165.56,"endTime":1170.56,"body":"about the recent announcement,"},{"startTime":1171.23,"endTime":1174.02,"body":"the agreement between the UK and the US,"},{"startTime":1174.02,"endTime":1176.99,"body":"where some of that was already announced,"},{"startTime":1176.99,"endTime":1180.17,"body":"but it's now been formally"},{"startTime":1176.99,"endTime":1180.17,"body":"kind of wrapped up in a bow"},{"startTime":1180.17,"endTime":1181.52,"body":"with this US agreement."},{"startTime":1181.52,"endTime":1184.31,"body":"So, we're seeing an"},{"startTime":1181.52,"endTime":1184.31,"body":"increase in nice thresholds,"},{"startTime":1184.31,"endTime":1188.21,"body":"but obviously, that's for"},{"startTime":1184.31,"endTime":1188.21,"body":"new products moving forward."},{"startTime":1188.21,"endTime":1190.13,"body":"There's also a commitment"},{"startTime":1190.13,"endTime":1195.13,"body":"to perhaps increase the"},{"startTime":1190.13,"endTime":1195.13,"body":"percentage spend on healthcare."},{"startTime":1195.68,"endTime":1198.95,"body":"Again, that was probably"},{"startTime":1195.68,"endTime":1198.95,"body":"already part of the agreed plan,"},{"startTime":1198.95,"endTime":1201.677,"body":"and it will only subsequently"},{"startTime":1198.95,"endTime":1201.677,"body":"affect future things."},{"startTime":1201.677,"endTime":1206.36,"body":"So, to me the in-market"},{"startTime":1201.677,"endTime":1206.36,"body":"products are generally facing"},{"startTime":1206.36,"endTime":1209.15,"body":"the situation that the"},{"startTime":1206.36,"endTime":1209.15,"body":"administration was hoping for,"},{"startTime":1209.15,"endTime":1212.51,"body":"that there would be some"},{"startTime":1209.15,"endTime":1212.51,"body":"narrowing of the corridor achieved"},{"startTime":1212.51,"endTime":1216.26,"body":"via reductions in the US,"},{"startTime":1216.26,"endTime":1218.39,"body":"well, rather increases in US rebates,"},{"startTime":1218.39,"endTime":1220.34,"body":"it's not going to affect the price per se."},{"startTime":1221.99,"endTime":1223.43,"body":"But I think it's interesting,"},{"startTime":1223.43,"endTime":1226.16,"body":"I think Michael's alluded to the fact,"},{"startTime":1226.16,"endTime":1228.95,"body":"it's meant to be all"},{"startTime":1226.16,"endTime":1228.95,"body":"products that are eligible,"},{"startTime":1228.95,"endTime":1231.02,"body":"but maybe there's some exceptions there."},{"startTime":1231.02,"endTime":1234.17,"body":"For those companies that are"},{"startTime":1231.02,"endTime":1234.17,"body":"not participating in GENEROUS"},{"startTime":1234.17,"endTime":1236.99,"body":"or have not got formal"},{"startTime":1234.17,"endTime":1236.99,"body":"agreements in place,"},{"startTime":1236.99,"endTime":1239.93,"body":"what happens to them,"},{"startTime":1236.99,"endTime":1239.93,"body":"how will they be pursued,"},{"startTime":1239.93,"endTime":1242.81,"body":"or is it just the general expectation"},{"startTime":1242.81,"endTime":1244.91,"body":"from the administration that"},{"startTime":1242.81,"endTime":1244.91,"body":"they should do something"},{"startTime":1244.91,"endTime":1247.01,"body":"and they need to plan for it?"},{"startTime":1247.01,"endTime":1248.66,"body":"I think the more interesting question is,"},{"startTime":1248.66,"endTime":1251.03,"body":"what do companies do in the future?"},{"startTime":1251.03,"endTime":1252.86,"body":"And I think there's two parts to it,"},{"startTime":1252.86,"endTime":1254.987,"body":"and I guess Clare can talk to one of those"},{"startTime":1254.987,"endTime":1256.88,"body":"and we can hand it off between us,"},{"startTime":1256.88,"endTime":1259.85,"body":"but the people that are about to launch,"},{"startTime":1259.85,"endTime":1263.24,"body":"and maybe the die is cast,"},{"startTime":1259.85,"endTime":1263.24,"body":"and the investment is there,"},{"startTime":1263.24,"endTime":1266.75,"body":"versus those that are planning"},{"startTime":1263.24,"endTime":1266.75,"body":"for longer term future."},{"startTime":1266.75,"endTime":1271.31,"body":"So, Clare, I'll hand it to"},{"startTime":1266.75,"endTime":1271.31,"body":"you to talk about one those."},{"startTime":1271.31,"endTime":1274.07,"body":"- I think that is probably"},{"startTime":1271.31,"endTime":1274.07,"body":"one of the more challenging,"},{"startTime":1274.07,"endTime":1277.94,"body":"'cause we don't know how that"},{"startTime":1274.07,"endTime":1277.94,"body":"will impact for companies"},{"startTime":1277.94,"endTime":1281.3,"body":"that have products about to"},{"startTime":1277.94,"endTime":1281.3,"body":"launch, but as Cathy said,"},{"startTime":1281.3,"endTime":1285.23,"body":"it's like moving the"},{"startTime":1281.3,"endTime":1285.23,"body":"goalposts during the game."},{"startTime":1285.23,"endTime":1287.36,"body":"The companies have already decided"},{"startTime":1287.36,"endTime":1289.13,"body":"what investments to make in trials,"},{"startTime":1289.13,"endTime":1292.61,"body":"they've already made"},{"startTime":1289.13,"endTime":1292.61,"body":"some revenue assumptions,"},{"startTime":1292.61,"endTime":1294.41,"body":"and thought about positioning and things,"},{"startTime":1294.41,"endTime":1298.1,"body":"and all of that work potentially"},{"startTime":1294.41,"endTime":1298.1,"body":"needs to be revisited."},{"startTime":1298.1,"endTime":1300.92,"body":"So, we are working with companies to try"},{"startTime":1300.92,"endTime":1303.86,"body":"to help them think about"},{"startTime":1300.92,"endTime":1303.86,"body":"scenarios that might crop up"},{"startTime":1303.86,"endTime":1306.59,"body":"and how to prepare for"},{"startTime":1303.86,"endTime":1306.59,"body":"those and what to do."},{"startTime":1306.59,"endTime":1309.77,"body":"But I think that is"},{"startTime":1306.59,"endTime":1309.77,"body":"quite a challenging area,"},{"startTime":1309.77,"endTime":1313.7,"body":"particularly, for those"},{"startTime":1309.77,"endTime":1313.7,"body":"that are about to launch"},{"startTime":1313.7,"endTime":1316.146,"body":"with all this uncertainty,"},{"startTime":1313.7,"endTime":1316.146,"body":"and as we've said,"},{"startTime":1316.146,"endTime":1318.56,"body":"it's changing almost on a daily basis."},{"startTime":1318.56,"endTime":1322.67,"body":"So, it can be quite"},{"startTime":1318.56,"endTime":1322.67,"body":"difficult to know exactly"},{"startTime":1322.67,"endTime":1325.47,"body":"what will happen and what"},{"startTime":1322.67,"endTime":1325.47,"body":"will be the right thing to do."},{"startTime":1326.39,"endTime":1328.64,"body":"- And I think, I mean, the companies"},{"startTime":1328.64,"endTime":1330.44,"body":"that we are collaborating with,"},{"startTime":1330.44,"endTime":1335.03,"body":"they very much said that it's"},{"startTime":1330.44,"endTime":1335.03,"body":"a thinking country by country,"},{"startTime":1335.03,"endTime":1340.03,"body":"literally considering,"},{"startTime":1335.03,"endTime":1340.03,"body":"okay, UK, what can be done?"},{"startTime":1340.4,"endTime":1341.6,"body":"Do we have to think differently?"},{"startTime":1341.6,"endTime":1345.8,"body":"Do we have to do a"},{"startTime":1341.6,"endTime":1345.8,"body":"subpopulation assessment?"},{"startTime":1345.8,"endTime":1347.27,"body":"Can we push this?"},{"startTime":1347.27,"endTime":1350.45,"body":"Is there the opportunity to engage more"},{"startTime":1350.45,"endTime":1353.663,"body":"with innovative agreements?"},{"startTime":1354.68,"endTime":1355.76,"body":"I mean, it sounds dreadful,"},{"startTime":1355.76,"endTime":1358.61,"body":"but that maybe make it"},{"startTime":1355.76,"endTime":1358.61,"body":"a little bit more opaque"},{"startTime":1358.61,"endTime":1362.27,"body":"to fully understand the true net level."},{"startTime":1362.27,"endTime":1364.79,"body":"I think historically, payers have always,"},{"startTime":1364.79,"endTime":1368.63,"body":"or rather in recent times,"},{"startTime":1364.79,"endTime":1368.63,"body":"there's been less interest"},{"startTime":1368.63,"endTime":1371.9,"body":"in engaging in very"},{"startTime":1368.63,"endTime":1371.9,"body":"complex outcomes agreements"},{"startTime":1371.9,"endTime":1375.71,"body":"or what have you, just the"},{"startTime":1371.9,"endTime":1375.71,"body":"administration and making it work"},{"startTime":1375.71,"endTime":1379.493,"body":"and the risk that the"},{"startTime":1375.71,"endTime":1379.493,"body":"payer's going to lose out."},{"startTime":1380.36,"endTime":1384.5,"body":"I do feel that perhaps"},{"startTime":1380.36,"endTime":1384.5,"body":"in this global context,"},{"startTime":1384.5,"endTime":1387.89,"body":"it's bigger than a single"},{"startTime":1384.5,"endTime":1387.89,"body":"company or a single product,"},{"startTime":1387.89,"endTime":1390.26,"body":"and maybe the authorities"},{"startTime":1387.89,"endTime":1390.26,"body":"in various countries"},{"startTime":1390.26,"endTime":1392.99,"body":"are going to have to be a"},{"startTime":1390.26,"endTime":1392.99,"body":"little bit more flexible"},{"startTime":1392.99,"endTime":1396.14,"body":"and a little bit more open"},{"startTime":1392.99,"endTime":1396.14,"body":"to that type of agreement."},{"startTime":1396.14,"endTime":1398.245,"body":"Because as we've sort of alluded,"},{"startTime":1398.245,"endTime":1401.57,"body":"the alternative is the risk"},{"startTime":1401.57,"endTime":1403.88,"body":"that if you are attending"},{"startTime":1401.57,"endTime":1403.88,"body":"to be a lower price market,"},{"startTime":1403.88,"endTime":1407.243,"body":"there may not be possible for"},{"startTime":1403.88,"endTime":1407.243,"body":"a pharma company to launch."},{"startTime":1408.565,"endTime":1409.73,"body":"Again, those that are familiar"},{"startTime":1409.73,"endTime":1412.79,"body":"with negotiation strategy in terms,"},{"startTime":1412.79,"endTime":1414.53,"body":"it's almost like pharma companies,"},{"startTime":1414.53,"endTime":1416.93,"body":"BATNA has improved a little bit."},{"startTime":1416.93,"endTime":1419.63,"body":"Your best alternative to"},{"startTime":1416.93,"endTime":1419.63,"body":"a negotiated agreement"},{"startTime":1419.63,"endTime":1421.94,"body":"has shifted a bit in your favour,"},{"startTime":1421.94,"endTime":1424.67,"body":"albeit that it's a challenging situation,"},{"startTime":1424.67,"endTime":1428.84,"body":"but you have more perhaps to bargain with."},{"startTime":1428.84,"endTime":1431.87,"body":"So, that's our hypothesis, right?"},{"startTime":1431.87,"endTime":1433.19,"body":"And who will know,"},{"startTime":1433.19,"endTime":1436.01,"body":"and there are some therapy"},{"startTime":1433.19,"endTime":1436.01,"body":"areas where they're too large,"},{"startTime":1436.01,"endTime":1438.23,"body":"it'd be just onerous to monitor"},{"startTime":1438.23,"endTime":1439.46,"body":"and track those types of things."},{"startTime":1439.46,"endTime":1441.65,"body":"But I think that is a possible solution"},{"startTime":1441.65,"endTime":1443.063,"body":"that's being considered."},{"startTime":1444.17,"endTime":1448.73,"body":"I think also broader agreements,"},{"startTime":1448.73,"endTime":1450.47,"body":"perhaps are thinking holistically trying"},{"startTime":1450.47,"endTime":1453.17,"body":"to help the payers thinking about a price"},{"startTime":1453.17,"endTime":1455.45,"body":"for delivering a service"},{"startTime":1455.45,"endTime":1457.55,"body":"rather than just the product itself,"},{"startTime":1457.55,"endTime":1460.97,"body":"which again, makes it harder"},{"startTime":1457.55,"endTime":1460.97,"body":"to unpick the net price,"},{"startTime":1460.97,"endTime":1463.16,"body":"but actually is providing"},{"startTime":1460.97,"endTime":1463.16,"body":"value for the payer"},{"startTime":1463.16,"endTime":1465.11,"body":"and not just holding them over a barrel"},{"startTime":1465.11,"endTime":1467.06,"body":"and pushing the price up."},{"startTime":1467.06,"endTime":1469.7,"body":"And I do think that policy,"},{"startTime":1469.7,"endTime":1472.01,"body":"broader policy change is necessary as well"},{"startTime":1472.01,"endTime":1474.86,"body":"to perhaps do what is"},{"startTime":1472.01,"endTime":1474.86,"body":"being done in the UK."},{"startTime":1474.86,"endTime":1479.86,"body":"Like perhaps encourage greater"},{"startTime":1474.86,"endTime":1479.86,"body":"openness to spend ex-US,"},{"startTime":1480.5,"endTime":1485.24,"body":"but we'll see how that all turns out."},{"startTime":1485.24,"endTime":1490.24,"body":"- So, Cathy, do you believe"},{"startTime":1485.24,"endTime":1490.24,"body":"that we will see a change again"},{"startTime":1490.4,"endTime":1494.84,"body":"to come back to, I will just"},{"startTime":1490.4,"endTime":1494.84,"body":"call it value-based contracts"},{"startTime":1494.84,"endTime":1498.68,"body":"or innovative contracts that"},{"startTime":1494.84,"endTime":1498.68,"body":"those will come back in favour?"},{"startTime":1498.68,"endTime":1503.003,"body":"Or will it just really be about dead net?"},{"startTime":1504.86,"endTime":1506.363,"body":"- I mean, it's so difficult."},{"startTime":1508.79,"endTime":1512.18,"body":"I think there was an element"},{"startTime":1508.79,"endTime":1512.18,"body":"within this UK-US agreement"},{"startTime":1512.18,"endTime":1517.18,"body":"that alluded to these types of agreements."},{"startTime":1517.4,"endTime":1520.07,"body":"I need to dig into and"},{"startTime":1517.4,"endTime":1520.07,"body":"understand that more."},{"startTime":1520.07,"endTime":1522.89,"body":"I just think it's an option."},{"startTime":1522.89,"endTime":1525.8,"body":"I think the ultimately what"},{"startTime":1522.89,"endTime":1525.8,"body":"companies should be doing,"},{"startTime":1525.8,"endTime":1530.39,"body":"and this is more where they"},{"startTime":1525.8,"endTime":1530.39,"body":"have longer runway to play with."},{"startTime":1530.39,"endTime":1532.28,"body":"If they're now thinking about an asset"},{"startTime":1532.28,"endTime":1535.31,"body":"that's launching a year"},{"startTime":1532.28,"endTime":1535.31,"body":"or two in the future,"},{"startTime":1535.31,"endTime":1537.59,"body":"or they're looking at their portfolio"},{"startTime":1537.59,"endTime":1538.73,"body":"and making decisions there,"},{"startTime":1538.73,"endTime":1540.89,"body":"I think, this is where"},{"startTime":1538.73,"endTime":1540.89,"body":"they have more ability"},{"startTime":1540.89,"endTime":1544.04,"body":"to make the right decisions"},{"startTime":1540.89,"endTime":1544.04,"body":"about do we truly invest,"},{"startTime":1544.04,"endTime":1547.73,"body":"do we pursue the right kind"},{"startTime":1544.04,"endTime":1547.73,"body":"of data that will enable us"},{"startTime":1547.73,"endTime":1552.11,"body":"to support an appropriate"},{"startTime":1547.73,"endTime":1552.11,"body":"global price in ex-US markets."},{"startTime":1552.11,"endTime":1555.35,"body":"Maybe it's greater investment"},{"startTime":1552.11,"endTime":1555.35,"body":"in a smaller number"},{"startTime":1555.35,"endTime":1559.58,"body":"of patients to get where they need to go."},{"startTime":1559.58,"endTime":1564.58,"body":"I think, if you are in a"},{"startTime":1559.58,"endTime":1564.58,"body":"situation where you have your data"},{"startTime":1564.59,"endTime":1567.41,"body":"and you've got to make a"},{"startTime":1564.59,"endTime":1567.41,"body":"decision how to make it work"},{"startTime":1567.41,"endTime":1570.32,"body":"in each country, I think it"},{"startTime":1567.41,"endTime":1570.32,"body":"will be country by country"},{"startTime":1570.32,"endTime":1571.22,"body":"what is possible."},{"startTime":1571.22,"endTime":1573.26,"body":"Some countries, the"},{"startTime":1571.22,"endTime":1573.26,"body":"infrastructure is there"},{"startTime":1573.26,"endTime":1575.45,"body":"to do those types of agreements."},{"startTime":1575.45,"endTime":1577.94,"body":"Some countries, it's just"},{"startTime":1575.45,"endTime":1577.94,"body":"much, much more difficult,"},{"startTime":1577.94,"endTime":1580.4,"body":"or it doesn't fly."},{"startTime":1580.4,"endTime":1582.08,"body":"Maybe there are alternative ways,"},{"startTime":1582.08,"endTime":1585.02,"body":"or maybe there's some"},{"startTime":1582.08,"endTime":1585.02,"body":"potential to collaborate."},{"startTime":1585.02,"endTime":1587.0,"body":"It's almost like we believe in the product"},{"startTime":1587.0,"endTime":1588.47,"body":"but we don't have the data yet."},{"startTime":1588.47,"endTime":1590.78,"body":"Can we do some sort of,"},{"startTime":1590.78,"endTime":1592.64,"body":"I don't know, conditional reimbursement,"},{"startTime":1592.64,"endTime":1594.17,"body":"not in the traditional sense"},{"startTime":1594.17,"endTime":1596.3,"body":"where it's just to gather the data,"},{"startTime":1596.3,"endTime":1598.7,"body":"but you set a price that"},{"startTime":1596.3,"endTime":1598.7,"body":"will work for the company,"},{"startTime":1598.7,"endTime":1601.643,"body":"and then you gather the"},{"startTime":1598.7,"endTime":1601.643,"body":"data that reinforces."},{"startTime":1602.99,"endTime":1604.58,"body":"I don't know, it's an option,"},{"startTime":1604.58,"endTime":1607.673,"body":"or it's looking at a more"},{"startTime":1604.58,"endTime":1607.673,"body":"restricted population,"},{"startTime":1609.529,"endTime":1613.31,"body":"or, yeah, delaying and"},{"startTime":1609.529,"endTime":1613.31,"body":"gathering that data separately,"},{"startTime":1613.31,"endTime":1616.07,"body":"or using those markets"},{"startTime":1613.31,"endTime":1616.07,"body":"where you can launch"},{"startTime":1616.07,"endTime":1618.83,"body":"and gathering real-world"},{"startTime":1616.07,"endTime":1618.83,"body":"evidence or be it,"},{"startTime":1618.83,"endTime":1621.59,"body":"that's less valuable for payers sometimes."},{"startTime":1621.59,"endTime":1624.83,"body":"But it is tricky and"},{"startTime":1621.59,"endTime":1624.83,"body":"companies are literally having"},{"startTime":1624.83,"endTime":1626.63,"body":"to think about it market by market."},{"startTime":1626.63,"endTime":1630.71,"body":"And we've also been working"},{"startTime":1626.63,"endTime":1630.71,"body":"with affiliate companies"},{"startTime":1630.71,"endTime":1633.05,"body":"to think, well, how should we be working"},{"startTime":1633.05,"endTime":1634.34,"body":"with the global team now?"},{"startTime":1634.34,"endTime":1635.54,"body":"What do we need to do?"},{"startTime":1635.54,"endTime":1638.99,"body":"Maybe our voice will be a"},{"startTime":1635.54,"endTime":1638.99,"body":"little bit more resonant"},{"startTime":1638.99,"endTime":1641.36,"body":"these days in terms of"},{"startTime":1638.99,"endTime":1641.36,"body":"the requests we're making"},{"startTime":1641.36,"endTime":1643.49,"body":"for particular data."},{"startTime":1643.49,"endTime":1647.54,"body":"Maybe that is, again, a positive outcome,"},{"startTime":1647.54,"endTime":1650.987,"body":"but it's expensive investing"},{"startTime":1647.54,"endTime":1650.987,"body":"in the right trials"},{"startTime":1650.987,"endTime":1654.02,"body":"for some of the evidence-based countries."},{"startTime":1654.02,"endTime":1655.241,"body":"- Perfect, thank you."},{"startTime":1655.241,"endTime":1660.241,"body":"And Michael, I guess, in the"},{"startTime":1655.241,"endTime":1660.241,"body":"US, the CMMI, piece of this,"},{"startTime":1661.55,"endTime":1664.37,"body":"can you maybe define that"},{"startTime":1661.55,"endTime":1664.37,"body":"a little bit for the group"},{"startTime":1664.37,"endTime":1667.52,"body":"and do we anticipate seeing more"},{"startTime":1667.52,"endTime":1670.82,"body":"and more participation there as well?"},{"startTime":1670.82,"endTime":1675.82,"body":"- Sure, so the CMMI has"},{"startTime":1670.82,"endTime":1675.82,"body":"always been an attempt"},{"startTime":1676.58,"endTime":1679.01,"body":"to try to test different pricing models."},{"startTime":1679.01,"endTime":1681.47,"body":"And so, when it was first"},{"startTime":1679.01,"endTime":1681.47,"body":"created, since that time,"},{"startTime":1681.47,"endTime":1685.04,"body":"there's been over right about"},{"startTime":1681.47,"endTime":1685.04,"body":"a hundred pricing models"},{"startTime":1685.04,"endTime":1686.63,"body":"that have come out that they've tried."},{"startTime":1686.63,"endTime":1690.8,"body":"They usually are in five-year timeframes"},{"startTime":1690.8,"endTime":1694.7,"body":"where they are trying to test those models"},{"startTime":1694.7,"endTime":1698.84,"body":"and go into ultimately"},{"startTime":1694.7,"endTime":1698.84,"body":"a evaluation period,"},{"startTime":1698.84,"endTime":1702.47,"body":"monitoring evaluation and"},{"startTime":1698.84,"endTime":1702.47,"body":"ultimately determination,"},{"startTime":1702.47,"endTime":1706.19,"body":"is there cost savings"},{"startTime":1702.47,"endTime":1706.19,"body":"associated with this model,"},{"startTime":1706.19,"endTime":1709.4,"body":"and/or improved health outcomes."},{"startTime":1709.4,"endTime":1713.45,"body":"And so, out of that, what"},{"startTime":1709.4,"endTime":1713.45,"body":"we've seen is about 25 models,"},{"startTime":1713.45,"endTime":1715.37,"body":"or so that ultimately became mandatory,"},{"startTime":1715.37,"endTime":1718.22,"body":"and actually have remained and applied."},{"startTime":1718.22,"endTime":1721.64,"body":"So, we're going to have to"},{"startTime":1718.22,"endTime":1721.64,"body":"watch and see what will happen"},{"startTime":1721.64,"endTime":1723.38,"body":"with these models going forward."},{"startTime":1723.38,"endTime":1726.05,"body":"Ultimately, again, that's"},{"startTime":1723.38,"endTime":1726.05,"body":"a big component of it,"},{"startTime":1726.05,"endTime":1729.23,"body":"is once we get whatever participation"},{"startTime":1729.23,"endTime":1731.09,"body":"we're going to have"},{"startTime":1729.23,"endTime":1731.09,"body":"from the manufacturers,"},{"startTime":1731.09,"endTime":1732.11,"body":"then the question is going to be"},{"startTime":1732.11,"endTime":1734.36,"body":"what participation do"},{"startTime":1732.11,"endTime":1734.36,"body":"we have in the states?"},{"startTime":1734.36,"endTime":1738.71,"body":"And ultimately, what is that"},{"startTime":1734.36,"endTime":1738.71,"body":"monitoring evaluation going"},{"startTime":1738.71,"endTime":1743.71,"body":"to show in terms of, what is the success?"},{"startTime":1743.75,"endTime":1744.92,"body":"And that's one of the things, Steve,"},{"startTime":1744.92,"endTime":1747.14,"body":"that I keep going back to is,"},{"startTime":1747.14,"endTime":1749.96,"body":"how is the administration going to assess"},{"startTime":1749.96,"endTime":1751.7,"body":"that it has been a success,"},{"startTime":1751.7,"endTime":1753.95,"body":"is it the number of manufacturers"},{"startTime":1753.95,"endTime":1756.44,"body":"that have joined and participated,"},{"startTime":1756.44,"endTime":1759.71,"body":"the number of states that are"},{"startTime":1756.44,"endTime":1759.71,"body":"using the drugs themselves?"},{"startTime":1759.71,"endTime":1762.23,"body":"Or again, is it going to be at the core,"},{"startTime":1762.23,"endTime":1766.07,"body":"the CMI model calculations"},{"startTime":1762.23,"endTime":1766.07,"body":"of did it save money,"},{"startTime":1766.07,"endTime":1767.84,"body":"and did it improve health outcomes?"},{"startTime":1767.84,"endTime":1770.81,"body":"So, there's a wide range"},{"startTime":1767.84,"endTime":1770.81,"body":"in trying to understand"},{"startTime":1770.81,"endTime":1773.06,"body":"and really raise the"},{"startTime":1770.81,"endTime":1773.06,"body":"question of what will happen"},{"startTime":1773.06,"endTime":1774.74,"body":"with these models going forward,"},{"startTime":1774.74,"endTime":1779.24,"body":"will they ultimately be"},{"startTime":1774.74,"endTime":1779.24,"body":"converted into mandatory models?"},{"startTime":1779.24,"endTime":1783.65,"body":"And again, we are so far"},{"startTime":1779.24,"endTime":1783.65,"body":"at the beginning of this"},{"startTime":1783.65,"endTime":1784.97,"body":"with just so much uncertainty"},{"startTime":1784.97,"endTime":1787.49,"body":"and I just go back to"},{"startTime":1784.97,"endTime":1787.49,"body":"what Cathy was saying,"},{"startTime":1787.49,"endTime":1790.193,"body":"the policy environment"},{"startTime":1787.49,"endTime":1790.193,"body":"is just changing so fast."},{"startTime":1791.33,"endTime":1793.49,"body":"By the time we get off this webinar,"},{"startTime":1793.49,"endTime":1794.94,"body":"there may already be changes."},{"startTime":1796.7,"endTime":1799.07,"body":"So, we're going to have"},{"startTime":1796.7,"endTime":1799.07,"body":"to see what happens"},{"startTime":1799.07,"endTime":1802.76,"body":"between now and after the midterms."},{"startTime":1802.76,"endTime":1806.03,"body":"Now, I personally believe"},{"startTime":1802.76,"endTime":1806.03,"body":"that lowering drug prices"},{"startTime":1806.03,"endTime":1807.62,"body":"of the US is a bipartisan issue,"},{"startTime":1807.62,"endTime":1809.93,"body":"I think it's supported by both sides."},{"startTime":1809.93,"endTime":1813.08,"body":"The question is what models"},{"startTime":1809.93,"endTime":1813.08,"body":"or what techniques are used"},{"startTime":1813.08,"endTime":1815.06,"body":"to make that accomplished?"},{"startTime":1815.06,"endTime":1818.03,"body":"And so, a lot of question"},{"startTime":1815.06,"endTime":1818.03,"body":"marks, and again,"},{"startTime":1818.03,"endTime":1822.597,"body":"I do think the midterm elections"},{"startTime":1818.03,"endTime":1822.597,"body":"are also going to be a time"},{"startTime":1823.58,"endTime":1826.73,"body":"for reflection to see where is"},{"startTime":1823.58,"endTime":1826.73,"body":"the new direction going to go"},{"startTime":1826.73,"endTime":1827.837,"body":"after that timeframe."},{"startTime":1827.837,"endTime":1830.121,"body":"And that's just about the time"},{"startTime":1830.121,"endTime":1832.49,"body":"when this first model"},{"startTime":1830.121,"endTime":1832.49,"body":"GENEROUS in particular"},{"startTime":1832.49,"endTime":1836.03,"body":"is going to be implemented"},{"startTime":1832.49,"endTime":1836.03,"body":"around that same timeframe."},{"startTime":1836.03,"endTime":1839.24,"body":"So, a lot of questions"},{"startTime":1836.03,"endTime":1839.24,"body":"still up in the air, Steve."},{"startTime":1839.24,"endTime":1840.38,"body":"- Perfect, thanks."},{"startTime":1840.38,"endTime":1843.38,"body":"And, Clare, kind of maybe"},{"startTime":1840.38,"endTime":1843.38,"body":"digging a little bit more"},{"startTime":1843.38,"endTime":1845.81,"body":"of what Cathy was mentioning before."},{"startTime":1845.81,"endTime":1850.81,"body":"What do companies or clients"},{"startTime":1845.81,"endTime":1850.81,"body":"need to be thinking about"},{"startTime":1851.0,"endTime":1856.0,"body":"in terms of the actual evidence"},{"startTime":1851.0,"endTime":1856.0,"body":"generation, population size?"},{"startTime":1856.55,"endTime":1861.44,"body":"What's the practical implication"},{"startTime":1856.55,"endTime":1861.44,"body":"about the value of the drug"},{"startTime":1861.44,"endTime":1863.453,"body":"or how to develop the value story?"},{"startTime":1865.16,"endTime":1866.78,"body":"- I think there's a few things"},{"startTime":1866.78,"endTime":1868.55,"body":"that companies can think about,"},{"startTime":1868.55,"endTime":1870.86,"body":"and really different strategies"},{"startTime":1870.86,"endTime":1874.64,"body":"and levers that can be used to help"},{"startTime":1874.64,"endTime":1876.83,"body":"to optimise their situation."},{"startTime":1876.83,"endTime":1881.83,"body":"So, Cathy did allude to"},{"startTime":1876.83,"endTime":1881.83,"body":"things like possibly limiting"},{"startTime":1882.38,"endTime":1883.79,"body":"the target population,"},{"startTime":1883.79,"endTime":1887.21,"body":"the label could consider"},{"startTime":1883.79,"endTime":1887.21,"body":"generating evidence"},{"startTime":1887.21,"endTime":1891.74,"body":"specifically for a defined"},{"startTime":1887.21,"endTime":1891.74,"body":"population that might lead"},{"startTime":1891.74,"endTime":1893.99,"body":"to potentially higher price potential,"},{"startTime":1893.99,"endTime":1895.703,"body":"but lower budget impact."},{"startTime":1897.26,"endTime":1900.2,"body":"Something to consider"},{"startTime":1897.26,"endTime":1900.2,"body":"maybe for rare disease,"},{"startTime":1900.2,"endTime":1903.68,"body":"but also for other areas too"},{"startTime":1903.68,"endTime":1905.549,"body":"where companies can think about,"},{"startTime":1905.549,"endTime":1908.66,"body":"where there is an area of high need"},{"startTime":1908.66,"endTime":1911.18,"body":"and defining a subpopulation"},{"startTime":1908.66,"endTime":1911.18,"body":"that might benefit"},{"startTime":1911.18,"endTime":1916.18,"body":"from new interventions,"},{"startTime":1911.18,"endTime":1916.18,"body":"so that's a possibility."},{"startTime":1916.22,"endTime":1920.15,"body":"And then, hand in hand with"},{"startTime":1916.22,"endTime":1920.15,"body":"that generating robust evidence"},{"startTime":1920.15,"endTime":1921.32,"body":"to meet payer needs."},{"startTime":1921.32,"endTime":1924.65,"body":"So, obviously, there'll"},{"startTime":1921.32,"endTime":1924.65,"body":"be a need to continue"},{"startTime":1924.65,"endTime":1929.27,"body":"to invest in trials that meet"},{"startTime":1924.65,"endTime":1929.27,"body":"requirements of key markets."},{"startTime":1929.27,"endTime":1931.1,"body":"There are some big European markets"},{"startTime":1931.1,"endTime":1933.8,"body":"that have some quite stringent"},{"startTime":1931.1,"endTime":1933.8,"body":"evidence requirements,"},{"startTime":1933.8,"endTime":1936.89,"body":"so that's not going to"},{"startTime":1933.8,"endTime":1936.89,"body":"change anytime soon."},{"startTime":1936.89,"endTime":1940.103,"body":"In fact, it might become"},{"startTime":1936.89,"endTime":1940.103,"body":"even more challenging."},{"startTime":1940.94,"endTime":1945.41,"body":"So, I think some due consideration"},{"startTime":1945.41,"endTime":1949.25,"body":"to what the right approaches"},{"startTime":1945.41,"endTime":1949.25,"body":"to generating evidence"},{"startTime":1949.25,"endTime":1951.053,"body":"will be very important."},{"startTime":1952.1,"endTime":1955.4,"body":"For example, head-to-head"},{"startTime":1952.1,"endTime":1955.4,"body":"trials with active comparators"},{"startTime":1955.4,"endTime":1959.27,"body":"where those are available,"},{"startTime":1955.4,"endTime":1959.27,"body":"payers love that sort of trial."},{"startTime":1959.27,"endTime":1963.32,"body":"It's nearly always requested or desired,"},{"startTime":1963.32,"endTime":1966.53,"body":"but, of course, it requires"},{"startTime":1963.32,"endTime":1966.53,"body":"planning and investment,"},{"startTime":1966.53,"endTime":1968.66,"body":"it's a bit more of a risk for companies,"},{"startTime":1968.66,"endTime":1970.52,"body":"and obviously, a bigger investment."},{"startTime":1970.52,"endTime":1975.52,"body":"So, lots of thought about"},{"startTime":1970.52,"endTime":1975.52,"body":"what might be possible,"},{"startTime":1975.98,"endTime":1977.96,"body":"what the potential outcomes would be."},{"startTime":1977.96,"endTime":1980.51,"body":"We are recommending to our"},{"startTime":1977.96,"endTime":1980.51,"body":"client scenario planning"},{"startTime":1980.51,"endTime":1983.45,"body":"and just really thinking"},{"startTime":1980.51,"endTime":1983.45,"body":"through all of the options"},{"startTime":1983.45,"endTime":1985.61,"body":"that are available as"},{"startTime":1983.45,"endTime":1985.61,"body":"well as what might change"},{"startTime":1985.61,"endTime":1986.443,"body":"in the future."},{"startTime":1986.443,"endTime":1989.45,"body":"But what options are open to them,"},{"startTime":1989.45,"endTime":1992.723,"body":"what might be the right"},{"startTime":1989.45,"endTime":1992.723,"body":"courses of action to consider."},{"startTime":1993.95,"endTime":1997.133,"body":"So, yeah, those are some"},{"startTime":1993.95,"endTime":1997.133,"body":"thoughts in response."},{"startTime":1997.97,"endTime":1998.803,"body":"- Perfect."},{"startTime":1998.803,"endTime":2000.13,"body":"So, you said differently,"},{"startTime":2000.13,"endTime":2005.13,"body":"do you think the information"},{"startTime":2000.13,"endTime":2005.13,"body":"that are going to be needed"},{"startTime":2006.82,"endTime":2009.34,"body":"in the US to justify"},{"startTime":2006.82,"endTime":2009.34,"body":"these prices will be there"},{"startTime":2009.34,"endTime":2011.983,"body":"if they've been there for"},{"startTime":2009.34,"endTime":2011.983,"body":"a while in Europe, right?"},{"startTime":2014.2,"endTime":2017.77,"body":"The evidence that's there"},{"startTime":2014.2,"endTime":2017.77,"body":"is rated and ranked,"},{"startTime":2017.77,"endTime":2021.25,"body":"and the evidence kind of drives"},{"startTime":2017.77,"endTime":2021.25,"body":"the value of the product."},{"startTime":2021.25,"endTime":2024.1,"body":"Do you think that we will"},{"startTime":2021.25,"endTime":2024.1,"body":"start to see that narrowing"},{"startTime":2024.1,"endTime":2028.21,"body":"of the gap that will be"},{"startTime":2024.1,"endTime":2028.21,"body":"required in the US as well,"},{"startTime":2028.21,"endTime":2031.093,"body":"because ultimately, you'll"},{"startTime":2028.21,"endTime":2031.093,"body":"need it for all the markets?"},{"startTime":2032.05,"endTime":2033.13,"body":"- Yeah, I think so."},{"startTime":2033.13,"endTime":2035.863,"body":"I think we're already seeing"},{"startTime":2033.13,"endTime":2035.863,"body":"trends of that nature,"},{"startTime":2036.849,"endTime":2038.56,"body":"and certainly outside the US,"},{"startTime":2038.56,"endTime":2040.72,"body":"and I would say within the US as well."},{"startTime":2040.72,"endTime":2044.95,"body":"I mean, it's something that"},{"startTime":2040.72,"endTime":2044.95,"body":"payers can easily ask for."},{"startTime":2044.95,"endTime":2048.34,"body":"They want to be convinced there's"},{"startTime":2044.95,"endTime":2048.34,"body":"always pressure on pricing"},{"startTime":2048.34,"endTime":2050.29,"body":"and that's increasing over time."},{"startTime":2050.29,"endTime":2053.8,"body":"So, it's definitely something"},{"startTime":2050.29,"endTime":2053.8,"body":"that if I was a payer"},{"startTime":2053.8,"endTime":2056.02,"body":"I'd be saying, I want to be convinced"},{"startTime":2056.02,"endTime":2057.43,"body":"of the value of the products."},{"startTime":2057.43,"endTime":2058.69,"body":"And how can we do that?"},{"startTime":2058.69,"endTime":2062.203,"body":"Well, I could put in some"},{"startTime":2058.69,"endTime":2062.203,"body":"requirements about the evidence"},{"startTime":2062.203,"endTime":2064.96,"body":"that I need and the"},{"startTime":2062.203,"endTime":2064.96,"body":"trial design and stuff."},{"startTime":2064.96,"endTime":2068.413,"body":"So, I think that certainly is"},{"startTime":2064.96,"endTime":2068.413,"body":"a trend that will continue."},{"startTime":2069.923,"endTime":2071.193,"body":"- Got it."},{"startTime":2069.923,"endTime":2071.193,"body":"- Yeah, and I guess in the US,"},{"startTime":2071.193,"endTime":2075.76,"body":"and the evidence is to support"},{"startTime":2071.193,"endTime":2075.76,"body":"up positioning and uptake,"},{"startTime":2075.76,"endTime":2078.58,"body":"and it's not ultimately"},{"startTime":2075.76,"endTime":2078.58,"body":"supporting your access"},{"startTime":2078.58,"endTime":2079.414,"body":"to the market,"},{"startTime":2079.414,"endTime":2082.75,"body":"well, I mean, within reason"},{"startTime":2079.414,"endTime":2082.75,"body":"obviously the regulatory step,"},{"startTime":2082.75,"endTime":2087.141,"body":"but it's not defining the"},{"startTime":2082.75,"endTime":2087.141,"body":"price, whereas in Europe it is,"},{"startTime":2087.141,"endTime":2087.974,"body":"and I think that's the difference."},{"startTime":2087.974,"endTime":2088.93,"body":"So, I think you're right, Steve,"},{"startTime":2088.93,"endTime":2093.93,"body":"that perhaps that difference"},{"startTime":2088.93,"endTime":2093.93,"body":"in evidence may be narrowing,"},{"startTime":2094.33,"endTime":2098.74,"body":"because maybe in the US you"},{"startTime":2094.33,"endTime":2098.74,"body":"are interested in generating"},{"startTime":2098.74,"endTime":2102.22,"body":"that data to support your"},{"startTime":2098.74,"endTime":2102.22,"body":"uptake later on post-launch,"},{"startTime":2102.22,"endTime":2106.48,"body":"but it's essential to getting you up"},{"startTime":2106.48,"endTime":2109.96,"body":"onto the right price"},{"startTime":2106.48,"endTime":2109.96,"body":"level in ex-US markets"},{"startTime":2109.96,"endTime":2114.96,"body":"to address this current focus"},{"startTime":2109.96,"endTime":2114.96,"body":"on MFN global corridors."},{"startTime":2116.41,"endTime":2118.81,"body":"- Yeah, it strikes me that,"},{"startTime":2118.81,"endTime":2120.07,"body":"I think you mentioned it earlier"},{"startTime":2120.07,"endTime":2123.58,"body":"that maybe you delay"},{"startTime":2120.07,"endTime":2123.58,"body":"launches in certain markets"},{"startTime":2123.58,"endTime":2127.93,"body":"to generate the data that"},{"startTime":2123.58,"endTime":2127.93,"body":"might be more difficult to do."},{"startTime":2127.93,"endTime":2130.84,"body":"So, you may have a launch"},{"startTime":2130.84,"endTime":2134.14,"body":"that the label is still"},{"startTime":2130.84,"endTime":2134.14,"body":"pretty thin at the beginning"},{"startTime":2134.14,"endTime":2135.22,"body":"and there's questions."},{"startTime":2135.22,"endTime":2139.36,"body":"So, do you think that if a manufacturer"},{"startTime":2139.36,"endTime":2142.81,"body":"will just say a rare"},{"startTime":2139.36,"endTime":2142.81,"body":"orphan product in the US"},{"startTime":2142.81,"endTime":2144.7,"body":"is able to get the product on market,"},{"startTime":2144.7,"endTime":2146.17,"body":"and then start generating data,"},{"startTime":2146.17,"endTime":2150.433,"body":"will that help increase"},{"startTime":2146.17,"endTime":2150.433,"body":"its value in Europe,"},{"startTime":2152.086,"endTime":2154.12,"body":"or should they still continue"},{"startTime":2154.12,"endTime":2156.88,"body":"to consider launching them simultaneously"},{"startTime":2156.88,"endTime":2161.26,"body":"as they more frequently do"},{"startTime":2156.88,"endTime":2161.26,"body":"today, and that's for anybody."},{"startTime":2161.26,"endTime":2162.482,"body":"- Yeah. (chuckles)"},{"startTime":2162.482,"endTime":2164.74,"body":"There's so many strands to it."},{"startTime":2164.74,"endTime":2166.9,"body":"I guess a very cynical view is,"},{"startTime":2166.9,"endTime":2168.88,"body":"at the end of the day, you need to launch"},{"startTime":2168.88,"endTime":2170.8,"body":"in the US and get revenue."},{"startTime":2170.8,"endTime":2173.59,"body":"I mean, particularly, if"},{"startTime":2170.8,"endTime":2173.59,"body":"you're a company with only one"},{"startTime":2173.59,"endTime":2175.12,"body":"or from product thing,"},{"startTime":2175.12,"endTime":2178.45,"body":"I think, launching simultaneously,"},{"startTime":2178.45,"endTime":2181.36,"body":"the Europe is not going"},{"startTime":2178.45,"endTime":2181.36,"body":"to view the typical data"},{"startTime":2181.36,"endTime":2182.68,"body":"that you might have."},{"startTime":2182.68,"endTime":2185.44,"body":"You can get approval for an orphan"},{"startTime":2185.44,"endTime":2190.44,"body":"where product in the US with"},{"startTime":2185.44,"endTime":2190.44,"body":"a less robust set of data"},{"startTime":2191.71,"endTime":2196.6,"body":"and you could probably set"},{"startTime":2191.71,"endTime":2196.6,"body":"a price that is validated."},{"startTime":2196.6,"endTime":2200.14,"body":"You're meeting an unmet need,"},{"startTime":2196.6,"endTime":2200.14,"body":"these horrible conditions,"},{"startTime":2200.14,"endTime":2201.4,"body":"patients need the product."},{"startTime":2201.4,"endTime":2203.5,"body":"You can get onto the"},{"startTime":2201.4,"endTime":2203.5,"body":"market with that price,"},{"startTime":2203.5,"endTime":2207.07,"body":"with that same single"},{"startTime":2203.5,"endTime":2207.07,"body":"arm, early phase two,"},{"startTime":2207.07,"endTime":2209.05,"body":"whatever data in Europe."},{"startTime":2209.05,"endTime":2211.78,"body":"Obviously, you can launch,"},{"startTime":2209.05,"endTime":2211.78,"body":"but it's more challenging,"},{"startTime":2211.78,"endTime":2214.63,"body":"and they are probably going"},{"startTime":2211.78,"endTime":2214.63,"body":"to have less of a view"},{"startTime":2214.63,"endTime":2215.56,"body":"of the value."},{"startTime":2215.56,"endTime":2218.86,"body":"So, I think, the difference"},{"startTime":2215.56,"endTime":2218.86,"body":"here will now be that"},{"startTime":2218.86,"endTime":2220.6,"body":"while you might well have just launched"},{"startTime":2220.6,"endTime":2223.87,"body":"and seen a big difference,"},{"startTime":2220.6,"endTime":2223.87,"body":"I think moving forward,"},{"startTime":2223.87,"endTime":2227.2,"body":"you're probably going to"},{"startTime":2223.87,"endTime":2227.2,"body":"launch in the US, get revenue,"},{"startTime":2227.2,"endTime":2229.99,"body":"and then as you say,"},{"startTime":2227.2,"endTime":2229.99,"body":"gather additional data,"},{"startTime":2229.99,"endTime":2232.825,"body":"whether it's real world US data,"},{"startTime":2232.825,"endTime":2235.69,"body":"or whether you continue"},{"startTime":2232.825,"endTime":2235.69,"body":"with a more robust trial."},{"startTime":2235.69,"endTime":2238.42,"body":"I think, probably European"},{"startTime":2235.69,"endTime":2238.42,"body":"payers are going to prefer"},{"startTime":2238.42,"endTime":2243.42,"body":"the RCT approach, but real-world"},{"startTime":2238.42,"endTime":2243.42,"body":"evidences is important,"},{"startTime":2244.69,"endTime":2246.55,"body":"and maybe that's another"},{"startTime":2244.69,"endTime":2246.55,"body":"area that will evolve,"},{"startTime":2246.55,"endTime":2249.67,"body":"like ensuring that we can"},{"startTime":2246.55,"endTime":2249.67,"body":"gather real-world evidence"},{"startTime":2249.67,"endTime":2251.83,"body":"in the US that is more appropriate"},{"startTime":2251.83,"endTime":2255.1,"body":"or applicable for ex-US evaluation"},{"startTime":2255.1,"endTime":2257.8,"body":"would be an interesting topic."},{"startTime":2257.8,"endTime":2258.633,"body":"- Perfect."},{"startTime":2258.633,"endTime":2259.753,"body":"Clare, anything to add there?"},{"startTime":2260.71,"endTime":2263.68,"body":"- So, if we're thinking"},{"startTime":2260.71,"endTime":2263.68,"body":"about the pros and cons"},{"startTime":2263.68,"endTime":2265.93,"body":"of delaying launch outside the US,"},{"startTime":2265.93,"endTime":2269.86,"body":"I think we also need to"},{"startTime":2265.93,"endTime":2269.86,"body":"consider other policies."},{"startTime":2269.86,"endTime":2271.81,"body":"It's not just all about MFN,"},{"startTime":2271.81,"endTime":2273.43,"body":"there are provisional changes"},{"startTime":2273.43,"endTime":2276.91,"body":"to conditional exclusivity in the EU."},{"startTime":2276.91,"endTime":2280.51,"body":"And these have been proposed"},{"startTime":2276.91,"endTime":2280.51,"body":"so as to increase access"},{"startTime":2280.51,"endTime":2283.42,"body":"to medicines across the EU and presumably"},{"startTime":2283.42,"endTime":2286.69,"body":"to encourage engagement"},{"startTime":2283.42,"endTime":2286.69,"body":"with the JCA process."},{"startTime":2286.69,"endTime":2289.96,"body":"And these changes will"},{"startTime":2286.69,"endTime":2289.96,"body":"potentially shorten the time"},{"startTime":2289.96,"endTime":2292.81,"body":"until generic and biosimilar competition,"},{"startTime":2292.81,"endTime":2295.15,"body":"and obviously, impact on"},{"startTime":2292.81,"endTime":2295.15,"body":"revenues by doing that."},{"startTime":2295.15,"endTime":2298.36,"body":"So, it's important to think about this"},{"startTime":2298.36,"endTime":2300.67,"body":"when considering the timing of launches"},{"startTime":2300.67,"endTime":2303.37,"body":"within and outside the US."},{"startTime":2303.37,"endTime":2305.89,"body":"So, if we think about"},{"startTime":2303.37,"endTime":2305.89,"body":"the current situation,"},{"startTime":2305.89,"endTime":2309.01,"body":"there's a baseline, well,"},{"startTime":2305.89,"endTime":2309.01,"body":"sorry, the proposed,"},{"startTime":2309.01,"endTime":2311.89,"body":"the baseline exclusivity"},{"startTime":2309.01,"endTime":2311.89,"body":"will be eight years"},{"startTime":2311.89,"endTime":2314.29,"body":"of data protection with"},{"startTime":2311.89,"endTime":2314.29,"body":"one additional year"},{"startTime":2314.29,"endTime":2315.52,"body":"of market protection"},{"startTime":2315.52,"endTime":2318.85,"body":"unless manufacturers"},{"startTime":2315.52,"endTime":2318.85,"body":"meet certain requirements"},{"startTime":2318.85,"endTime":2323.697,"body":"and the requirements are"},{"startTime":2318.85,"endTime":2323.697,"body":"numerous, but some of them include"},{"startTime":2324.85,"endTime":2327.19,"body":"whether a product addresses"},{"startTime":2324.85,"endTime":2327.19,"body":"an unmet medical need."},{"startTime":2327.19,"endTime":2329.11,"body":"So, that's where perhaps the rare"},{"startTime":2329.11,"endTime":2332.71,"body":"and orphan conditions come into play."},{"startTime":2332.71,"endTime":2335.26,"body":"If the product brings a"},{"startTime":2332.71,"endTime":2335.26,"body":"significant clinical benefit"},{"startTime":2335.26,"endTime":2337.96,"body":"that confers some additional protection,"},{"startTime":2337.96,"endTime":2341.53,"body":"and if the product contains"},{"startTime":2337.96,"endTime":2341.53,"body":"a new active substance"},{"startTime":2341.53,"endTime":2343.93,"body":"and meets certain conditions"},{"startTime":2341.53,"endTime":2343.93,"body":"for clinical trials,"},{"startTime":2343.93,"endTime":2346.63,"body":"so as we've been saying, for example here,"},{"startTime":2346.63,"endTime":2349.18,"body":"conducting comparative clinical trials"},{"startTime":2349.18,"endTime":2350.64,"body":"in several member states,"},{"startTime":2350.64,"endTime":2352.12,"body":"so we're talking about the EU here,"},{"startTime":2352.12,"endTime":2356.05,"body":"so they want multiple"},{"startTime":2352.12,"endTime":2356.05,"body":"European trial centres."},{"startTime":2356.05,"endTime":2359.59,"body":"And most importantly, perhaps"},{"startTime":2356.05,"endTime":2359.59,"body":"the manufacturer has to apply"},{"startTime":2359.59,"endTime":2363.1,"body":"for more marketing"},{"startTime":2359.59,"endTime":2363.1,"body":"authorization within 90 days"},{"startTime":2363.1,"endTime":2366.1,"body":"of the first marketing"},{"startTime":2363.1,"endTime":2366.1,"body":"authorization outside the EU."},{"startTime":2366.1,"endTime":2369.82,"body":"So, if you are talking about"},{"startTime":2366.1,"endTime":2369.82,"body":"delaying launch outside the US,"},{"startTime":2369.82,"endTime":2371.29,"body":"you've got to make a decision"},{"startTime":2371.29,"endTime":2374.053,"body":"whether you want to launch in Europe,"},{"startTime":2375.13,"endTime":2378.13,"body":"and the impact of the"},{"startTime":2375.13,"endTime":2378.13,"body":"timing of that decision,"},{"startTime":2378.13,"endTime":2380.71,"body":"'cause if you delay longer than 90 days,"},{"startTime":2380.71,"endTime":2385.06,"body":"you lose out on 12 months"},{"startTime":2380.71,"endTime":2385.06,"body":"of additional exclusivity."},{"startTime":2385.06,"endTime":2387.673,"body":"So, that could be quite significant."},{"startTime":2388.57,"endTime":2390.58,"body":"So, yeah, obviously, companies will need"},{"startTime":2390.58,"endTime":2394.363,"body":"to weigh up the timing, the"},{"startTime":2390.58,"endTime":2394.363,"body":"scale of the European launch."},{"startTime":2395.23,"endTime":2398.23,"body":"I think as we've said, the"},{"startTime":2395.23,"endTime":2398.23,"body":"US is no longer a source"},{"startTime":2398.23,"endTime":2401.59,"body":"of safety net when it comes to price."},{"startTime":2401.59,"endTime":2405.673,"body":"We will probably see at least"},{"startTime":2401.59,"endTime":2405.673,"body":"some movement of pricing,"},{"startTime":2406.54,"endTime":2409.42,"body":"although, as we've said"},{"startTime":2406.54,"endTime":2409.42,"body":"with all the caveats"},{"startTime":2409.42,"endTime":2411.043,"body":"that things are changing."},{"startTime":2412.18,"endTime":2413.5,"body":"But it's another thing that companies"},{"startTime":2413.5,"endTime":2415.873,"body":"will need to wrestle with and think about."},{"startTime":2417.716,"endTime":2420.4,"body":"And as Cathy mentioned,"},{"startTime":2417.716,"endTime":2420.4,"body":"it could impact patients,"},{"startTime":2420.4,"endTime":2424.58,"body":"'cause if they're delaying or"},{"startTime":2420.4,"endTime":2424.58,"body":"even choosing not to launch"},{"startTime":2425.998,"endTime":2429.04,"body":"in certain markets, then, of"},{"startTime":2425.998,"endTime":2429.04,"body":"course, that impacts patients."},{"startTime":2429.04,"endTime":2430.45,"body":"And then, there could be other pressures"},{"startTime":2430.45,"endTime":2433.78,"body":"from policy and patient groups and so on."},{"startTime":2433.78,"endTime":2435.37,"body":"So, it's really important"},{"startTime":2435.37,"endTime":2438.1,"body":"to think about all of these things."},{"startTime":2438.1,"endTime":2439.93,"body":"And then, on the flip side,"},{"startTime":2439.93,"endTime":2443.08,"body":"if companies are going"},{"startTime":2439.93,"endTime":2443.08,"body":"to launch in Europe,"},{"startTime":2443.08,"endTime":2445.507,"body":"then they do need to think about JCA"},{"startTime":2445.507,"endTime":2448.3,"body":"and the timing required there,"},{"startTime":2448.3,"endTime":2450.16,"body":"it's been well talked about already,"},{"startTime":2450.16,"endTime":2451.99,"body":"but there's a hundred day clock,"},{"startTime":2451.99,"endTime":2456.4,"body":"which starts once there's"},{"startTime":2451.99,"endTime":2456.4,"body":"an intention to launch."},{"startTime":2456.4,"endTime":2460.87,"body":"And companies have to"},{"startTime":2456.4,"endTime":2460.87,"body":"get all this very heavy,"},{"startTime":2460.87,"endTime":2464.26,"body":"robust evidence together in that time,"},{"startTime":2464.26,"endTime":2466.84,"body":"including things like"},{"startTime":2464.26,"endTime":2466.84,"body":"anticipating the PICOS,"},{"startTime":2466.84,"endTime":2469.57,"body":"generating the evidence that's needed."},{"startTime":2469.57,"endTime":2472.09,"body":"And again, that puts pressure"},{"startTime":2469.57,"endTime":2472.09,"body":"on timely decision making."},{"startTime":2472.09,"endTime":2475.54,"body":"So, there's a lot of things"},{"startTime":2472.09,"endTime":2475.54,"body":"that have to be considered"},{"startTime":2475.54,"endTime":2477.85,"body":"and as early as possible really,"},{"startTime":2477.85,"endTime":2479.56,"body":"and that doesn't make things any easier,"},{"startTime":2479.56,"endTime":2481.243,"body":"I don't think for companies."},{"startTime":2484.824,"endTime":2486.61,"body":"- I was going to say, as"},{"startTime":2484.824,"endTime":2486.61,"body":"I listen to you speak,"},{"startTime":2486.61,"endTime":2490.18,"body":"there are just so many"},{"startTime":2486.61,"endTime":2490.18,"body":"variables here to consider."},{"startTime":2490.18,"endTime":2494.14,"body":"There probably isn't,"},{"startTime":2490.18,"endTime":2494.14,"body":"I'll say, a right answer,"},{"startTime":2494.14,"endTime":2496.93,"body":"if in fact your right answer"},{"startTime":2494.14,"endTime":2496.93,"body":"is based off of revenue,"},{"startTime":2496.93,"endTime":2497.95,"body":"there's probably a different answer"},{"startTime":2497.95,"endTime":2502.03,"body":"if it's based off a patient,"},{"startTime":2497.95,"endTime":2502.03,"body":"with a lot of these drugs,"},{"startTime":2502.03,"endTime":2506.23,"body":"get access to these drugs to"},{"startTime":2502.03,"endTime":2506.23,"body":"patients as quick as possible."},{"startTime":2506.23,"endTime":2508.39,"body":"And it's just interesting"},{"startTime":2508.39,"endTime":2511.72,"body":"that there's just so many"},{"startTime":2508.39,"endTime":2511.72,"body":"things to consider here."},{"startTime":2511.72,"endTime":2513.55,"body":"Cathy, I cut you off there."},{"startTime":2513.55,"endTime":2518.55,"body":"- No, no, I think I was just"},{"startTime":2513.55,"endTime":2518.55,"body":"observing that in one way,"},{"startTime":2520.12,"endTime":2525.12,"body":"this is a bit of a dampener"},{"startTime":2520.12,"endTime":2525.12,"body":"on potential revenue."},{"startTime":2526.54,"endTime":2530.95,"body":"At the same time it's also, you"},{"startTime":2526.54,"endTime":2530.95,"body":"could try to get around that"},{"startTime":2530.95,"endTime":2534.49,"body":"by greater investment to provide the data"},{"startTime":2534.49,"endTime":2537.793,"body":"and get ready for JCA and global launch."},{"startTime":2538.81,"endTime":2541.633,"body":"So, it's almost like,"},{"startTime":2538.81,"endTime":2541.633,"body":"there's a sort of seesaw,"},{"startTime":2542.74,"endTime":2545.44,"body":"and I think, it really"},{"startTime":2542.74,"endTime":2545.44,"body":"very, very much depends"},{"startTime":2545.44,"endTime":2549.37,"body":"on a company's individual situation,"},{"startTime":2549.37,"endTime":2552.583,"body":"like how many products they've"},{"startTime":2549.37,"endTime":2552.583,"body":"got, what kind of product,"},{"startTime":2554.32,"endTime":2557.14,"body":"and making the right decisions"},{"startTime":2554.32,"endTime":2557.14,"body":"about their pipeline,"},{"startTime":2557.14,"endTime":2558.94,"body":"and investing in the right way."},{"startTime":2558.94,"endTime":2561.61,"body":"Because as you say, if it's"},{"startTime":2558.94,"endTime":2561.61,"body":"purely based on revenue,"},{"startTime":2561.61,"endTime":2565.363,"body":"then it might be quite a stark decision."},{"startTime":2566.47,"endTime":2571.0,"body":"And there may be some markets"},{"startTime":2566.47,"endTime":2571.0,"body":"that are missing out here,"},{"startTime":2571.0,"endTime":2573.67,"body":"or people taking the plunge."},{"startTime":2573.67,"endTime":2574.96,"body":"And actually, as you say, Clare,"},{"startTime":2574.96,"endTime":2578.68,"body":"the engaging with the risk"},{"startTime":2574.96,"endTime":2578.68,"body":"of generating the right data"},{"startTime":2578.68,"endTime":2581.32,"body":"that would support the price"},{"startTime":2578.68,"endTime":2581.32,"body":"that you think is appropriate."},{"startTime":2581.32,"endTime":2583.99,"body":"And that can be achieved in the US"},{"startTime":2583.99,"endTime":2587.68,"body":"to balance out the global pricing."},{"startTime":2587.68,"endTime":2589.78,"body":"But I do think people have"},{"startTime":2587.68,"endTime":2589.78,"body":"to make that assessment"},{"startTime":2589.78,"endTime":2591.28,"body":"for their own company."},{"startTime":2591.28,"endTime":2595.123,"body":"'Cause we're working with"},{"startTime":2591.28,"endTime":2595.123,"body":"organisations who are smaller,"},{"startTime":2596.2,"endTime":2600.22,"body":"maybe they've set the price"},{"startTime":2596.2,"endTime":2600.22,"body":"in the US or they're about to,"},{"startTime":2600.22,"endTime":2603.4,"body":"and then, they may historically"},{"startTime":2600.22,"endTime":2603.4,"body":"have been thinking,"},{"startTime":2603.4,"endTime":2605.89,"body":"considering launch"},{"startTime":2603.4,"endTime":2605.89,"body":"themselves or partnering."},{"startTime":2605.89,"endTime":2609.23,"body":"It's very challenging to evaluate"},{"startTime":2611.05,"endTime":2613.27,"body":"what the value of the product is ex-US,"},{"startTime":2613.27,"endTime":2617.47,"body":"and do you want to lose"},{"startTime":2613.27,"endTime":2617.47,"body":"control of the strategy"},{"startTime":2617.47,"endTime":2619.45,"body":"in those markets, because it obviously,"},{"startTime":2619.45,"endTime":2623.17,"body":"has an influence on your US revenue too."},{"startTime":2623.17,"endTime":2625.39,"body":"It's very, very tricky."},{"startTime":2625.39,"endTime":2626.223,"body":"- Yeah."},{"startTime":2626.223,"endTime":2627.477,"body":"And Michael, just thinking about this"},{"startTime":2627.477,"endTime":2630.94,"body":"from a Medicaid perspective."},{"startTime":2630.94,"endTime":2635.53,"body":"So many drugs that are"},{"startTime":2630.94,"endTime":2635.53,"body":"coming out are paediatric,"},{"startTime":2635.53,"endTime":2639.643,"body":"and they have such a bit profound"},{"startTime":2635.53,"endTime":2639.643,"body":"impact on people's lives."},{"startTime":2642.04,"endTime":2645.19,"body":"SMA, muscular dystrophy,"},{"startTime":2645.19,"endTime":2647.26,"body":"there's just a lot of"},{"startTime":2645.19,"endTime":2647.26,"body":"agents in the pipeline,"},{"startTime":2647.26,"endTime":2651.19,"body":"I think we've heard it called"},{"startTime":2647.26,"endTime":2651.19,"body":"the $400 billion question."},{"startTime":2651.19,"endTime":2653.35,"body":"There's so many drugs in the pipeline"},{"startTime":2653.35,"endTime":2655.27,"body":"that are getting ready to come out."},{"startTime":2655.27,"endTime":2659.59,"body":"How are states thinking"},{"startTime":2655.27,"endTime":2659.59,"body":"about the affordability here?"},{"startTime":2659.59,"endTime":2662.263,"body":"If prices potentially go up in the US,"},{"startTime":2663.991,"endTime":2666.46,"body":"and the Medicaid budgets"},{"startTime":2663.991,"endTime":2666.46,"body":"generally need to be"},{"startTime":2666.46,"endTime":2670.873,"body":"on a balanced level,"},{"startTime":2666.46,"endTime":2670.873,"body":"what does that look like?"},{"startTime":2672.34,"endTime":2673.78,"body":"Is there a tipping point here"},{"startTime":2673.78,"endTime":2676.387,"body":"where people just say, \"Enough.\""},{"startTime":2678.46,"endTime":2680.38,"body":"- Steve, that's a great question,"},{"startTime":2680.38,"endTime":2683.89,"body":"because we've already"},{"startTime":2680.38,"endTime":2683.89,"body":"started seeing it just as we,"},{"startTime":2683.89,"endTime":2686.11,"body":"again, starting with SMA"},{"startTime":2683.89,"endTime":2686.11,"body":"and some of the others,"},{"startTime":2686.11,"endTime":2689.71,"body":"and then, moving into most recently"},{"startTime":2689.71,"endTime":2692.62,"body":"metachromatic leukodystrophy"},{"startTime":2689.71,"endTime":2692.62,"body":"and some of the others"},{"startTime":2692.62,"endTime":2696.4,"body":"that when we see those"},{"startTime":2692.62,"endTime":2696.4,"body":"dollar amounts go up,"},{"startTime":2696.4,"endTime":2699.22,"body":"yeah, that state budget"},{"startTime":2696.4,"endTime":2699.22,"body":"pressure does become huge."},{"startTime":2699.22,"endTime":2701.92,"body":"But because of that paediatric indication,"},{"startTime":2701.92,"endTime":2705.1,"body":"there's a huge caveat that"},{"startTime":2701.92,"endTime":2705.1,"body":"states have to deal with."},{"startTime":2705.1,"endTime":2708.28,"body":"And that is the federal requirement"},{"startTime":2708.28,"endTime":2712.09,"body":"under Medicaid of early"},{"startTime":2708.28,"endTime":2712.09,"body":"periodic screening, diagnostic,"},{"startTime":2712.09,"endTime":2714.64,"body":"and treatment, EPSDT."},{"startTime":2714.64,"endTime":2717.07,"body":"That provision of Medicaid"},{"startTime":2714.64,"endTime":2717.07,"body":"law basically says"},{"startTime":2717.07,"endTime":2722.07,"body":"that any state of a child"},{"startTime":2717.07,"endTime":2722.07,"body":"presents with a medical condition"},{"startTime":2723.34,"endTime":2726.91,"body":"whether or not that state"},{"startTime":2723.34,"endTime":2726.91,"body":"actually covers that benefit"},{"startTime":2726.91,"endTime":2731.71,"body":"in this case, maybe that high"},{"startTime":2726.91,"endTime":2731.71,"body":"cost drug or that treatment,"},{"startTime":2731.71,"endTime":2732.67,"body":"they have to do it,"},{"startTime":2732.67,"endTime":2734.98,"body":"they have to find a way to make it happen."},{"startTime":2734.98,"endTime":2736.9,"body":"And there's only a very few reasons"},{"startTime":2736.9,"endTime":2740.14,"body":"that a state is allowed to not cover it."},{"startTime":2740.14,"endTime":2743.83,"body":"And so, they ultimately are"},{"startTime":2740.14,"endTime":2743.83,"body":"going to have to look at"},{"startTime":2743.83,"endTime":2745.42,"body":"how do I build it into my budget?"},{"startTime":2745.42,"endTime":2748.09,"body":"How do I sit there and address it,"},{"startTime":2748.09,"endTime":2750.76,"body":"because I've got to cover"},{"startTime":2748.09,"endTime":2750.76,"body":"it for these children."},{"startTime":2750.76,"endTime":2752.803,"body":"And if they ultimately, if they don't,"},{"startTime":2754.813,"endTime":2757.57,"body":"they're going to wind up"},{"startTime":2754.813,"endTime":2757.57,"body":"ultimately into the federal courts,"},{"startTime":2757.57,"endTime":2759.04,"body":"they're going to have to"},{"startTime":2757.57,"endTime":2759.04,"body":"come in and intervene."},{"startTime":2759.04,"endTime":2761.77,"body":"So, states are very aware"},{"startTime":2759.04,"endTime":2761.77,"body":"of that requirement,"},{"startTime":2761.77,"endTime":2764.11,"body":"and so they're going to"},{"startTime":2761.77,"endTime":2764.11,"body":"build a budget around it."},{"startTime":2764.11,"endTime":2767.62,"body":"But at the same time, and"},{"startTime":2764.11,"endTime":2767.62,"body":"I don't want to digress,"},{"startTime":2767.62,"endTime":2770.32,"body":"but at the same time,"},{"startTime":2767.62,"endTime":2770.32,"body":"states are also dealing"},{"startTime":2770.32,"endTime":2772.09,"body":"with the effects of H.R.1,"},{"startTime":2772.09,"endTime":2775.72,"body":"the One Big Beautiful Bill Act from 2025."},{"startTime":2775.72,"endTime":2777.85,"body":"And those provisions are starting"},{"startTime":2777.85,"endTime":2779.95,"body":"to become implemented right now,"},{"startTime":2779.95,"endTime":2783.58,"body":"which is putting even"},{"startTime":2779.95,"endTime":2783.58,"body":"additional budget pressures on."},{"startTime":2783.58,"endTime":2786.22,"body":"So, the short answer is that ironically"},{"startTime":2786.22,"endTime":2788.02,"body":"for the paediatric indication,"},{"startTime":2788.02,"endTime":2789.64,"body":"they're probably still"},{"startTime":2788.02,"endTime":2789.64,"body":"going to get covered."},{"startTime":2789.64,"endTime":2793.45,"body":"The question is, who else"},{"startTime":2789.64,"endTime":2793.45,"body":"is not going to get covered,"},{"startTime":2793.45,"endTime":2796.39,"body":"or what benefits are going to"},{"startTime":2793.45,"endTime":2796.39,"body":"be reduced for other persons"},{"startTime":2796.39,"endTime":2798.28,"body":"that are in those Medicaid programmes,"},{"startTime":2798.28,"endTime":2803.02,"body":"and how are state going to"},{"startTime":2798.28,"endTime":2803.02,"body":"ultimately figure that issue out?"},{"startTime":2803.02,"endTime":2806.11,"body":"And we already see it"},{"startTime":2803.02,"endTime":2806.11,"body":"now where we have drugs"},{"startTime":2806.11,"endTime":2809.8,"body":"that are approved only"},{"startTime":2806.11,"endTime":2809.8,"body":"for paediatric population,"},{"startTime":2809.8,"endTime":2813.19,"body":"even if it's one that"},{"startTime":2809.8,"endTime":2813.19,"body":"bridges into adulthood."},{"startTime":2813.19,"endTime":2815.26,"body":"So, it's a great question, Steve,"},{"startTime":2815.26,"endTime":2818.83,"body":"but kids are going to"},{"startTime":2815.26,"endTime":2818.83,"body":"ultimately get the coverage,"},{"startTime":2818.83,"endTime":2820.33,"body":"states are going to have"},{"startTime":2818.83,"endTime":2820.33,"body":"to struggle to figure out"},{"startTime":2820.33,"endTime":2821.623,"body":"how to balance a budget."},{"startTime":2822.97,"endTime":2824.02,"body":"- Perfect, thank you."},{"startTime":2825.34,"endTime":2826.54,"body":"It's amazing."},{"startTime":2826.54,"endTime":2829.81,"body":"There's so many drugs and development"},{"startTime":2829.81,"endTime":2832.45,"body":"that are really going to change"},{"startTime":2829.81,"endTime":2832.45,"body":"people's lives, we see it,"},{"startTime":2832.45,"endTime":2835.21,"body":"and now we're all going to have"},{"startTime":2832.45,"endTime":2835.21,"body":"to figure out more and more"},{"startTime":2835.21,"endTime":2836.59,"body":"how to pay for it."},{"startTime":2836.59,"endTime":2840.55,"body":"And at the same time, how we"},{"startTime":2836.59,"endTime":2840.55,"body":"started the conversation is,"},{"startTime":2840.55,"endTime":2841.81,"body":"the US I think is looking"},{"startTime":2841.81,"endTime":2845.92,"body":"to reduce its overall exposure and cost,"},{"startTime":2845.92,"endTime":2848.68,"body":"but it almost feels like"},{"startTime":2845.92,"endTime":2848.68,"body":"the unintended consequences,"},{"startTime":2848.68,"endTime":2853.42,"body":"maybe in the short term"},{"startTime":2848.68,"endTime":2853.42,"body":"that it will not ease."},{"startTime":2853.42,"endTime":2855.43,"body":"So, I guess the bigger question is,"},{"startTime":2855.43,"endTime":2857.68,"body":"I understand the construct"},{"startTime":2855.43,"endTime":2857.68,"body":"or how we threw it out there,"},{"startTime":2857.68,"endTime":2862.68,"body":"which is MFN is supposed to"},{"startTime":2857.68,"endTime":2862.68,"body":"help reduce cost for Americans"},{"startTime":2865.15,"endTime":2867.79,"body":"and people living in the United States,"},{"startTime":2867.79,"endTime":2872.307,"body":"but in fact it may have"},{"startTime":2867.79,"endTime":2872.307,"body":"the opposite impact."},{"startTime":2874.06,"endTime":2876.16,"body":"I mean, dare I be so cynical?"},{"startTime":2876.16,"endTime":2878.893,"body":"So, I guess the question is knowing that,"},{"startTime":2880.03,"endTime":2882.82,"body":"how do you think the"},{"startTime":2880.03,"endTime":2882.82,"body":"administration is going to react"},{"startTime":2882.82,"endTime":2884.773,"body":"when prices really don't fall?"},{"startTime":2887.89,"endTime":2890.5,"body":"How do we navigate that or manage that?"},{"startTime":2890.5,"endTime":2894.01,"body":"- Yeah, Steve, it really"},{"startTime":2890.5,"endTime":2894.01,"body":"gets back to that question"},{"startTime":2894.01,"endTime":2895.24,"body":"that I was asking earlier,"},{"startTime":2895.24,"endTime":2897.973,"body":"how is the administration"},{"startTime":2895.24,"endTime":2897.973,"body":"going to judge success?"},{"startTime":2899.23,"endTime":2902.02,"body":"If I put a cynical hat on it,"},{"startTime":2902.02,"endTime":2904.87,"body":"I will say that the"},{"startTime":2902.02,"endTime":2904.87,"body":"administration will say"},{"startTime":2904.87,"endTime":2908.41,"body":"that we have a large"},{"startTime":2904.87,"endTime":2908.41,"body":"amount of manufacturers"},{"startTime":2908.41,"endTime":2909.91,"body":"that came to the table."},{"startTime":2909.91,"endTime":2912.91,"body":"They have offered tremendous reductions"},{"startTime":2912.91,"endTime":2914.98,"body":"in the prescription drug pricing,"},{"startTime":2914.98,"endTime":2918.88,"body":"and it is going to improve access"},{"startTime":2918.88,"endTime":2921.31,"body":"to care all the way around."},{"startTime":2921.31,"endTime":2925.1,"body":"And we just don't know what"},{"startTime":2921.31,"endTime":2925.1,"body":"information is going to be used"},{"startTime":2927.766,"endTime":2930.1,"body":"to show that that's"},{"startTime":2927.766,"endTime":2930.1,"body":"exactly what's happening."},{"startTime":2930.1,"endTime":2934.69,"body":"I think that it's going to"},{"startTime":2930.1,"endTime":2934.69,"body":"be the administration saying"},{"startTime":2934.69,"endTime":2937.183,"body":"that they have achieved their goals."},{"startTime":2938.399,"endTime":2941.41,"body":"And then, I think that they'll"},{"startTime":2938.399,"endTime":2941.41,"body":"probably push back by some,"},{"startTime":2941.41,"endTime":2943.99,"body":"especially the states,"},{"startTime":2941.41,"endTime":2943.99,"body":"'cause they're looking"},{"startTime":2943.99,"endTime":2946.09,"body":"at whether or not they're"},{"startTime":2943.99,"endTime":2946.09,"body":"actually saving money,"},{"startTime":2946.09,"endTime":2949.36,"body":"and then ultimately,"},{"startTime":2946.09,"endTime":2949.36,"body":"you're going to have CMMI,"},{"startTime":2949.36,"endTime":2951.4,"body":"in five years, they're"},{"startTime":2949.36,"endTime":2951.4,"body":"going to have to come up"},{"startTime":2951.4,"endTime":2954.193,"body":"with the data to say, did"},{"startTime":2951.4,"endTime":2954.193,"body":"the model work or not?"},{"startTime":2955.18,"endTime":2957.93,"body":"But that's going to be after"},{"startTime":2955.18,"endTime":2957.93,"body":"this administration has left."},{"startTime":2959.042,"endTime":2961.15,"body":"So, how does that all play out?"},{"startTime":2961.15,"endTime":2963.52,"body":"In the meantime, I"},{"startTime":2961.15,"endTime":2963.52,"body":"think the administration"},{"startTime":2963.52,"endTime":2966.7,"body":"is going to probably"},{"startTime":2963.52,"endTime":2966.7,"body":"claim success early on"},{"startTime":2966.7,"endTime":2969.16,"body":"before we actually have"},{"startTime":2966.7,"endTime":2969.16,"body":"the data to really support"},{"startTime":2969.16,"endTime":2972.103,"body":"whether or not that's accurate statement."},{"startTime":2973.347,"endTime":2974.18,"body":"- Yeah."},{"startTime":2974.18,"endTime":2977.473,"body":"There's lots of public"},{"startTime":2974.18,"endTime":2977.473,"body":"announcements about engagement,"},{"startTime":2978.73,"endTime":2981.49,"body":"and more products launching onto TrumpRx,"},{"startTime":2981.49,"endTime":2985.483,"body":"and this kind of thing"},{"startTime":2981.49,"endTime":2985.483,"body":"like the visible agreement"},{"startTime":2987.58,"endTime":2989.26,"body":"to participate is something."},{"startTime":2989.26,"endTime":2992.77,"body":"I think it'll be intriguing"},{"startTime":2989.26,"endTime":2992.77,"body":"to see the extent"},{"startTime":2992.77,"endTime":2994.58,"body":"to which new launching products"},{"startTime":2997.382,"endTime":2998.27,"body":"for different types of companies,"},{"startTime":2998.27,"endTime":3000.903,"body":"shall we say are pursued."},{"startTime":3003.39,"endTime":3006.42,"body":"For smaller companies that"},{"startTime":3003.39,"endTime":3006.42,"body":"haven't made formal agreements,"},{"startTime":3006.42,"endTime":3010.38,"body":"or haven't engaged, is there"},{"startTime":3006.42,"endTime":3010.38,"body":"going to be some flexibility?"},{"startTime":3010.38,"endTime":3012.63,"body":"Is there an acknowledgement"},{"startTime":3010.38,"endTime":3012.63,"body":"that it could be,"},{"startTime":3013.466,"endTime":3016.65,"body":"a very different situation"},{"startTime":3013.466,"endTime":3016.65,"body":"for those smaller companies."},{"startTime":3016.65,"endTime":3020.403,"body":"I think that would be very"},{"startTime":3016.65,"endTime":3020.403,"body":"interesting to follow."},{"startTime":3021.63,"endTime":3025.203,"body":"- So, kind of related to"},{"startTime":3021.63,"endTime":3025.203,"body":"that, Clare and Cathy,"},{"startTime":3026.79,"endTime":3029.88,"body":"is it possible just to"},{"startTime":3026.79,"endTime":3029.88,"body":"have separate strategies,"},{"startTime":3029.88,"endTime":3033.87,"body":"one for the US and one"},{"startTime":3029.88,"endTime":3033.87,"body":"for the global market?"},{"startTime":3033.87,"endTime":3036.54,"body":"Or are we at the point,"},{"startTime":3036.54,"endTime":3038.55,"body":"because of everything"},{"startTime":3036.54,"endTime":3038.55,"body":"that you've mentioned,"},{"startTime":3038.55,"endTime":3039.66,"body":"all of these variables,"},{"startTime":3039.66,"endTime":3042.33,"body":"do you need to have one"},{"startTime":3039.66,"endTime":3042.33,"body":"giant cohesive strategy,"},{"startTime":3042.33,"endTime":3043.89,"body":"even if that means that you may not launch"},{"startTime":3043.89,"endTime":3048.45,"body":"in certain markets, is it"},{"startTime":3043.89,"endTime":3048.45,"body":"possible to leave it separate,"},{"startTime":3048.45,"endTime":3052.14,"body":"or is it now, companies really"},{"startTime":3048.45,"endTime":3052.14,"body":"need to think this through"},{"startTime":3052.14,"endTime":3056.163,"body":"at the highest level as early as possible?"},{"startTime":3058.08,"endTime":3059.52,"body":"- That's a great question, I can start,"},{"startTime":3059.52,"endTime":3060.843,"body":"and Cathy can chip in."},{"startTime":3062.04,"endTime":3065.46,"body":"Yeah, I think it is important"},{"startTime":3062.04,"endTime":3065.46,"body":"to have collaboration"},{"startTime":3065.46,"endTime":3067.92,"body":"and think about the strategy as a whole."},{"startTime":3067.92,"endTime":3070.35,"body":"I mean, it's still possible"},{"startTime":3067.92,"endTime":3070.35,"body":"to have separate strategies"},{"startTime":3070.35,"endTime":3072.18,"body":"of course for the US and outside,"},{"startTime":3072.18,"endTime":3075.39,"body":"but I think, I suppose"},{"startTime":3072.18,"endTime":3075.39,"body":"what's important is thinking"},{"startTime":3075.39,"endTime":3077.88,"body":"about making the decisions early,"},{"startTime":3077.88,"endTime":3079.71,"body":"having the right information"},{"startTime":3079.71,"endTime":3081.69,"body":"in your hands to allow you to do that."},{"startTime":3081.69,"endTime":3083.463,"body":"Thinking about the pros and cons,"},{"startTime":3084.456,"endTime":3089.456,"body":"and what effects each decision"},{"startTime":3084.456,"endTime":3089.456,"body":"might have on revenues,"},{"startTime":3089.82,"endTime":3091.11,"body":"but also on patients,"},{"startTime":3091.11,"endTime":3094.92,"body":"and on launch optimization"},{"startTime":3091.11,"endTime":3094.92,"body":"in every country."},{"startTime":3094.92,"endTime":3099.27,"body":"So, there probably isn't a"},{"startTime":3094.92,"endTime":3099.27,"body":"right or wrong answer to that,"},{"startTime":3099.27,"endTime":3102.33,"body":"but we have internally been"},{"startTime":3099.27,"endTime":3102.33,"body":"discussing the importance"},{"startTime":3102.33,"endTime":3106.727,"body":"of companies collaborating"},{"startTime":3102.33,"endTime":3106.727,"body":"internally with affiliates"},{"startTime":3106.727,"endTime":3111.72,"body":"and sharing their expectations"},{"startTime":3106.727,"endTime":3111.72,"body":"and the data that they have,"},{"startTime":3111.72,"endTime":3114.9,"body":"and making those decisions together"},{"startTime":3114.9,"endTime":3116.04,"body":"so that people are happy."},{"startTime":3116.04,"endTime":3119.46,"body":"I mean, there's so many different"},{"startTime":3116.04,"endTime":3119.46,"body":"light and shade to this,"},{"startTime":3119.46,"endTime":3123.093,"body":"it's quite hard to give"},{"startTime":3119.46,"endTime":3123.093,"body":"a fully detailed answer."},{"startTime":3125.25,"endTime":3126.96,"body":"If pushed I would probably say yes,"},{"startTime":3126.96,"endTime":3130.5,"body":"it's important to think"},{"startTime":3126.96,"endTime":3130.5,"body":"about the strategy as a whole"},{"startTime":3130.5,"endTime":3133.62,"body":"and not as two separate things."},{"startTime":3133.62,"endTime":3134.943,"body":"- Yeah, I would agree."},{"startTime":3138.51,"endTime":3140.43,"body":"It's going to be more"},{"startTime":3138.51,"endTime":3140.43,"body":"joined up, it has to be,"},{"startTime":3140.43,"endTime":3144.3,"body":"even if it's to decide"},{"startTime":3140.43,"endTime":3144.3,"body":"to kill something early,"},{"startTime":3144.3,"endTime":3146.22,"body":"or only launch it in the US."},{"startTime":3146.22,"endTime":3147.12,"body":"Right from the get go"},{"startTime":3147.12,"endTime":3150.57,"body":"and plan your investment"},{"startTime":3147.12,"endTime":3150.57,"body":"in trials accordingly."},{"startTime":3150.57,"endTime":3153.45,"body":"Or if it's yes, we've worked out a way"},{"startTime":3153.45,"endTime":3155.76,"body":"to make this product work globally,"},{"startTime":3155.76,"endTime":3157.26,"body":"and we're going to"},{"startTime":3155.76,"endTime":3157.26,"body":"invest in the right trial"},{"startTime":3157.26,"endTime":3158.43,"body":"to support that globally."},{"startTime":3158.43,"endTime":3161.28,"body":"I think it very much has"},{"startTime":3158.43,"endTime":3161.28,"body":"to be more joined up both"},{"startTime":3161.28,"endTime":3164.7,"body":"in terms of, I know this"},{"startTime":3161.28,"endTime":3164.7,"body":"sounds a little bit silly,"},{"startTime":3164.7,"endTime":3167.4,"body":"obviously, there is this"},{"startTime":3164.7,"endTime":3167.4,"body":"joined up thinking already,"},{"startTime":3167.4,"endTime":3170.52,"body":"but in our experience,"},{"startTime":3167.4,"endTime":3170.52,"body":"sometimes the US and global"},{"startTime":3170.52,"endTime":3172.293,"body":"can be a bit more separate."},{"startTime":3173.4,"endTime":3176.94,"body":"And so, I think there'll be"},{"startTime":3173.4,"endTime":3176.94,"body":"more aligned thinking there."},{"startTime":3176.94,"endTime":3180.99,"body":"Plus, as Clare alluded"},{"startTime":3176.94,"endTime":3180.99,"body":"to, more early input"},{"startTime":3180.99,"endTime":3182.7,"body":"and validation with the affiliates."},{"startTime":3182.7,"endTime":3185.643,"body":"Again, that's obviously occurring already,"},{"startTime":3186.6,"endTime":3189.87,"body":"but I feel like there"},{"startTime":3186.6,"endTime":3189.87,"body":"might be more weight behind"},{"startTime":3189.87,"endTime":3191.877,"body":"what is requested or asked for."},{"startTime":3191.877,"endTime":3193.65,"body":"And people need to be realistic,"},{"startTime":3193.65,"endTime":3194.767,"body":"sometimes, I think there's a,"},{"startTime":3194.767,"endTime":3197.79,"body":"\"Oh, yes, it might be challenging,"},{"startTime":3194.767,"endTime":3197.79,"body":"but let's just carry on.\""},{"startTime":3197.79,"endTime":3200.37,"body":"But no, I think it really"},{"startTime":3197.79,"endTime":3200.37,"body":"is going to be essential"},{"startTime":3200.37,"endTime":3202.68,"body":"to make the right decisions early."},{"startTime":3202.68,"endTime":3204.78,"body":"Are we going to invest, well,"},{"startTime":3202.68,"endTime":3204.78,"body":"are we not going to invest,"},{"startTime":3204.78,"endTime":3208.113,"body":"and make an appropriate plan."},{"startTime":3210.72,"endTime":3211.89,"body":"- Sorry."},{"startTime":3211.89,"endTime":3212.723,"body":"I just wanted to say,"},{"startTime":3212.723,"endTime":3215.7,"body":"maybe it's more difficult"},{"startTime":3212.723,"endTime":3215.7,"body":"to change your mind"},{"startTime":3215.7,"endTime":3217.29,"body":"or adapt the strategy."},{"startTime":3217.29,"endTime":3219.57,"body":"It's probably more important"},{"startTime":3217.29,"endTime":3219.57,"body":"to make decisions early"},{"startTime":3219.57,"endTime":3220.53,"body":"and stick with them,"},{"startTime":3220.53,"endTime":3225.06,"body":"because it's probably"},{"startTime":3220.53,"endTime":3225.06,"body":"less possible to change"},{"startTime":3225.06,"endTime":3227.31,"body":"or adapt strategies later on"},{"startTime":3227.31,"endTime":3229.743,"body":"without having significant effects."},{"startTime":3231.33,"endTime":3232.23,"body":"- Perfect, thank you."},{"startTime":3232.23,"endTime":3235.77,"body":"So, maybe final question"},{"startTime":3232.23,"endTime":3235.77,"body":"for each of you is,"},{"startTime":3235.77,"endTime":3238.44,"body":"where will we be in five years?"},{"startTime":3238.44,"endTime":3241.47,"body":"So, things are happening fast and furious."},{"startTime":3241.47,"endTime":3242.67,"body":"It's a hard question,"},{"startTime":3242.67,"endTime":3246.6,"body":"because things are"},{"startTime":3242.67,"endTime":3246.6,"body":"changing hourly, weekly,"},{"startTime":3246.6,"endTime":3249.75,"body":"and even from a media perspective,"},{"startTime":3249.75,"endTime":3251.13,"body":"we're just on a different clock,"},{"startTime":3251.13,"endTime":3255.21,"body":"but if you were to forecast"},{"startTime":3251.13,"endTime":3255.21,"body":"where we're in five years,"},{"startTime":3255.21,"endTime":3257.49,"body":"what do you need to be thinking about"},{"startTime":3257.49,"endTime":3259.68,"body":"if you're a pharmaceutical manufacturers"},{"startTime":3259.68,"endTime":3261.453,"body":"as it relates to these policies?"},{"startTime":3262.74,"endTime":3264.74,"body":"So, maybe, Michael, I'll start with you."},{"startTime":3266.433,"endTime":3267.663,"body":"- I think in five years,"},{"startTime":3269.49,"endTime":3273.39,"body":"I think that the focus will"},{"startTime":3269.49,"endTime":3273.39,"body":"still is not going to be lost"},{"startTime":3273.39,"endTime":3278.37,"body":"on ultimately what is the"},{"startTime":3273.39,"endTime":3278.37,"body":"pricing that is in the US"},{"startTime":3278.37,"endTime":3279.9,"body":"versus in other countries."},{"startTime":3279.9,"endTime":3282.93,"body":"I think that that is still"},{"startTime":3279.9,"endTime":3282.93,"body":"going to be a question mark"},{"startTime":3282.93,"endTime":3284.79,"body":"that's going to be out there,"},{"startTime":3284.79,"endTime":3289.79,"body":"and are people in the US"},{"startTime":3284.79,"endTime":3289.79,"body":"paying a disproportionate"},{"startTime":3289.89,"endTime":3293.13,"body":"amount relative to those other countries?"},{"startTime":3293.13,"endTime":3295.14,"body":"I still think that that will be a question"},{"startTime":3295.14,"endTime":3296.7,"body":"that will still be out there."},{"startTime":3296.7,"endTime":3298.86,"body":"I don't think that we're"},{"startTime":3296.7,"endTime":3298.86,"body":"going to solve for it."},{"startTime":3298.86,"endTime":3301.23,"body":"I think that it'll be interesting to see"},{"startTime":3301.23,"endTime":3304.92,"body":"how much of a change we do see."},{"startTime":3304.92,"endTime":3308.64,"body":"I think that you will see"},{"startTime":3304.92,"endTime":3308.64,"body":"some downward pressures,"},{"startTime":3308.64,"endTime":3311.31,"body":"and that we will see some areas,"},{"startTime":3311.31,"endTime":3315.33,"body":"and I'll say it that way,"},{"startTime":3311.31,"endTime":3315.33,"body":"some therapeutic categories,"},{"startTime":3315.33,"endTime":3319.68,"body":"where I think you'll"},{"startTime":3315.33,"endTime":3319.68,"body":"see probably more change"},{"startTime":3319.68,"endTime":3321.84,"body":"than other categories."},{"startTime":3321.84,"endTime":3323.73,"body":"I can't pick those out at this moment,"},{"startTime":3323.73,"endTime":3325.38,"body":"but I do think that'll happen."},{"startTime":3325.38,"endTime":3329.353,"body":"The biggest question really is"},{"startTime":3325.38,"endTime":3329.353,"body":"going to be the next step is,"},{"startTime":3330.66,"endTime":3333.81,"body":"how much it is going to go back"},{"startTime":3333.81,"endTime":3336.69,"body":"to what we were talking about earlier,"},{"startTime":3336.69,"endTime":3338.7,"body":"evidence that's going to be used to say"},{"startTime":3338.7,"endTime":3342.21,"body":"whether or not this drug"},{"startTime":3338.7,"endTime":3342.21,"body":"is really as effective"},{"startTime":3342.21,"endTime":3343.14,"body":"as it needs to be."},{"startTime":3343.14,"endTime":3345.54,"body":"I think that's going to be"},{"startTime":3343.14,"endTime":3345.54,"body":"one of the biggest changes"},{"startTime":3345.54,"endTime":3347.1,"body":"that come out of this is,"},{"startTime":3347.1,"endTime":3349.65,"body":"I think, additional effort in the US"},{"startTime":3349.65,"endTime":3352.563,"body":"to really raise that"},{"startTime":3349.65,"endTime":3352.563,"body":"question of effectiveness."},{"startTime":3353.85,"endTime":3357.72,"body":"So that's where I'll put my"},{"startTime":3353.85,"endTime":3357.72,"body":"hat at this moment at time."},{"startTime":3357.72,"endTime":3358.74,"body":"- Perfect, thank you."},{"startTime":3358.74,"endTime":3360.093,"body":"Cathy, what's your wager?"},{"startTime":3361.14,"endTime":3362.49,"body":"- Oh, it's tricky, isn't it?"},{"startTime":3362.49,"endTime":3365.22,"body":"But yeah, for sure, I don't"},{"startTime":3362.49,"endTime":3365.22,"body":"think this is going away."},{"startTime":3366.447,"endTime":3369.023,"body":"The extent to which it has an impact,"},{"startTime":3369.023,"endTime":3371.46,"body":"I think we will see some narrowing,"},{"startTime":3371.46,"endTime":3375.6,"body":"but I think, the ultimate"},{"startTime":3371.46,"endTime":3375.6,"body":"systems of evaluation"},{"startTime":3375.6,"endTime":3378.27,"body":"in the ex-US markets are not"},{"startTime":3375.6,"endTime":3378.27,"body":"going to formally change,"},{"startTime":3378.27,"endTime":3383.27,"body":"but maybe there'll be some"},{"startTime":3378.27,"endTime":3383.27,"body":"more, as I say above product,"},{"startTime":3384.96,"endTime":3389.01,"body":"above company, just more"},{"startTime":3384.96,"endTime":3389.01,"body":"country to country agreements,"},{"startTime":3389.01,"endTime":3392.55,"body":"or alignment on what is appropriate."},{"startTime":3392.55,"endTime":3395.67,"body":"Because I think that will be necessary"},{"startTime":3395.67,"endTime":3398.46,"body":"to prevent some of the"},{"startTime":3395.67,"endTime":3398.46,"body":"natural consequences"},{"startTime":3398.46,"endTime":3401.46,"body":"of a business having to"},{"startTime":3398.46,"endTime":3401.46,"body":"make an unfortunate decision"},{"startTime":3401.46,"endTime":3402.495,"body":"about access for patients."},{"startTime":3402.495,"endTime":3406.29,"body":"So, I do think it's going"},{"startTime":3402.495,"endTime":3406.29,"body":"to be broader policy pieces"},{"startTime":3406.29,"endTime":3408.75,"body":"like we are seeing with the UK and the US."},{"startTime":3408.75,"endTime":3411.84,"body":"That being said, I mean,"},{"startTime":3408.75,"endTime":3411.84,"body":"I don't know to an extent"},{"startTime":3411.84,"endTime":3415.89,"body":"how what's been agreed there"},{"startTime":3411.84,"endTime":3415.89,"body":"will actually come into being."},{"startTime":3415.89,"endTime":3418.62,"body":"It's not like some of"},{"startTime":3415.89,"endTime":3418.62,"body":"it can be implemented,"},{"startTime":3418.62,"endTime":3420.87,"body":"you can't force a manufacturer to engage"},{"startTime":3420.87,"endTime":3422.703,"body":"with something necessarily."},{"startTime":3424.05,"endTime":3427.98,"body":"And I do think, maybe we're"},{"startTime":3424.05,"endTime":3427.98,"body":"going to see perhaps more,"},{"startTime":3427.98,"endTime":3430.68,"body":"depends on the therapy"},{"startTime":3427.98,"endTime":3430.68,"body":"area, but more products,"},{"startTime":3430.68,"endTime":3432.84,"body":"an option which we"},{"startTime":3430.68,"endTime":3432.84,"body":"didn't talk about earlier"},{"startTime":3432.84,"endTime":3436.38,"body":"is maybe more private access."},{"startTime":3436.38,"endTime":3438.39,"body":"I mean, obviously, there"},{"startTime":3436.38,"endTime":3438.39,"body":"are some therapy areas"},{"startTime":3438.39,"endTime":3440.22,"body":"where that's not going to be appropriate,"},{"startTime":3440.22,"endTime":3443.55,"body":"but maybe a solution for"},{"startTime":3440.22,"endTime":3443.55,"body":"some companies in some areas"},{"startTime":3443.55,"endTime":3445.26,"body":"is to have more products"},{"startTime":3445.26,"endTime":3447.6,"body":"that are going effectively"},{"startTime":3445.26,"endTime":3447.6,"body":"\"non-reimbursed.\""},{"startTime":3447.6,"endTime":3449.91,"body":"You can set the price at the level"},{"startTime":3449.91,"endTime":3451.05,"body":"that you think is appropriate."},{"startTime":3451.05,"endTime":3455.46,"body":"It still obviously counts"},{"startTime":3451.05,"endTime":3455.46,"body":"towards the MFN type calculation,"},{"startTime":3455.46,"endTime":3458.28,"body":"but you have control over that."},{"startTime":3458.28,"endTime":3462.36,"body":"But obviously, that doesn't"},{"startTime":3458.28,"endTime":3462.36,"body":"work for all therapy areas,"},{"startTime":3462.36,"endTime":3464.13,"body":"but it's hard."},{"startTime":3462.36,"endTime":3464.13,"body":"- Perfect, thank you."},{"startTime":3464.13,"endTime":3465.81,"body":"- The crystal ball is hard. (chuckles)"},{"startTime":3465.81,"endTime":3466.86,"body":"- Yes."},{"startTime":3466.86,"endTime":3469.293,"body":"And what do you see in"},{"startTime":3466.86,"endTime":3469.293,"body":"your crystal ball, Clare?"},{"startTime":3470.79,"endTime":3472.08,"body":"- I think it'd be interesting to see"},{"startTime":3472.08,"endTime":3476.31,"body":"how other countries will"},{"startTime":3472.08,"endTime":3476.31,"body":"react to all these changes."},{"startTime":3476.31,"endTime":3478.44,"body":"What policies might be put into place"},{"startTime":3478.44,"endTime":3481.83,"body":"to ensure continued access for patients"},{"startTime":3481.83,"endTime":3485.25,"body":"to new innovations in other countries."},{"startTime":3485.25,"endTime":3490.25,"body":"I mean, the EU changes"},{"startTime":3485.25,"endTime":3490.25,"body":"that are being proposed,"},{"startTime":3490.62,"endTime":3493.62,"body":"have happened independently"},{"startTime":3490.62,"endTime":3493.62,"body":"to some degree at least,"},{"startTime":3493.62,"endTime":3495.0,"body":"but there might be others."},{"startTime":3495.0,"endTime":3497.91,"body":"I mean, I think we"},{"startTime":3495.0,"endTime":3497.91,"body":"might see some consortia"},{"startTime":3497.91,"endTime":3500.91,"body":"of countries looking at policies to try"},{"startTime":3500.91,"endTime":3505.91,"body":"to encourage companies to"},{"startTime":3500.91,"endTime":3505.91,"body":"still launch outside the US."},{"startTime":3506.85,"endTime":3511.44,"body":"I think there is a risk that"},{"startTime":3506.85,"endTime":3511.44,"body":"some companies may think"},{"startTime":3511.44,"endTime":3516.27,"body":"that that's a possible lever"},{"startTime":3511.44,"endTime":3516.27,"body":"that they can pull at least."},{"startTime":3516.27,"endTime":3521.27,"body":"And if that does happen, then"},{"startTime":3516.27,"endTime":3521.27,"body":"payers and healthcare systems"},{"startTime":3522.51,"endTime":3526.11,"body":"and patients, of course, in"},{"startTime":3522.51,"endTime":3526.11,"body":"those countries will want to do"},{"startTime":3526.11,"endTime":3527.71,"body":"what they can to ensure"},{"startTime":3529.05,"endTime":3531.84,"body":"that companies still see"},{"startTime":3529.05,"endTime":3531.84,"body":"launching there as attractive."},{"startTime":3531.84,"endTime":3534.87,"body":"So, I think we may see"},{"startTime":3531.84,"endTime":3534.87,"body":"some changes going back"},{"startTime":3534.87,"endTime":3536.07,"body":"to the domino effect."},{"startTime":3536.07,"endTime":3539.28,"body":"I don't think this is the only thing"},{"startTime":3539.28,"endTime":3540.93,"body":"that's going to happen in isolation."},{"startTime":3540.93,"endTime":3544.32,"body":"I think there will be other"},{"startTime":3540.93,"endTime":3544.32,"body":"things that happen too."},{"startTime":3544.32,"endTime":3545.55,"body":"I agree there probably"},{"startTime":3545.55,"endTime":3548.46,"body":"will be some downward movement in prices,"},{"startTime":3548.46,"endTime":3553.323,"body":"but I don't think that's"},{"startTime":3548.46,"endTime":3553.323,"body":"the only consequence of MFN."},{"startTime":3554.16,"endTime":3555.39,"body":"- Perfect, thank you."},{"startTime":3555.39,"endTime":3557.25,"body":"Well, I wanted to thank"},{"startTime":3555.39,"endTime":3557.25,"body":"our panellists today"},{"startTime":3557.25,"endTime":3558.87,"body":"for sharing the reviews."},{"startTime":3558.87,"endTime":3562.923,"body":"Really insightful, very complicated topic."},{"startTime":3564.24,"endTime":3567.39,"body":"Really interesting topic as"},{"startTime":3564.24,"endTime":3567.39,"body":"well as we try to figure out"},{"startTime":3567.39,"endTime":3571.47,"body":"how to match value to some"},{"startTime":3567.39,"endTime":3571.47,"body":"of these lifesaving drugs"},{"startTime":3571.47,"endTime":3573.99,"body":"that are out in the marketplace."},{"startTime":3573.99,"endTime":3576.6,"body":"So, thank you for your"},{"startTime":3573.99,"endTime":3576.6,"body":"participation today."},{"startTime":3576.6,"endTime":3578.37,"body":"For those that joined,"},{"startTime":3578.37,"endTime":3580.41,"body":"thank you for taking your time"},{"startTime":3580.41,"endTime":3583.77,"body":"to talk with Petauri and Artia today"},{"startTime":3583.77,"endTime":3588.51,"body":"about some of the expertise"},{"startTime":3583.77,"endTime":3588.51,"body":"that we have on staff."},{"startTime":3588.51,"endTime":3590.82,"body":"We do have a host of"},{"startTime":3588.51,"endTime":3590.82,"body":"questions that have come in"},{"startTime":3590.82,"endTime":3593.52,"body":"that we are going to follow up with,"},{"startTime":3593.52,"endTime":3595.59,"body":"specifically for each and everyone,"},{"startTime":3595.59,"endTime":3597.3,"body":"and we really appreciate it."},{"startTime":3597.3,"endTime":3600.543,"body":"So, thank you very much"},{"startTime":3597.3,"endTime":3600.543,"body":"and I wish you a great day."}]}