Insights from JP Morgan 2026 with Liz Fowler, PhD, JD

Commercial health plans may have been missing from J.P. Morgan 2026, but government had a big presence! Value-Based Voices host Burt Zweigenhaft, PhD, and nationally recognized health policy expert Liz Fowler, PhD, JD, share their observations from this year’s meeting and key insights around most-favored nation prescription drug pricing, 340B, PBMs, Medicare site neutrality, AI, and of course value-based care. 

Contact Value-Based Voices

- Follow AVBCC on LinkedIn  

- View our podcast lineup 

- Contact us at info@avbcc.org

Thanks for listening! 

Transcript

Value‑Based Voices 

Featuring: Burt Zweigenhaft, PhD & Liz Fowler, PhD, JD

[00:00] – BURT:
Welcome to Value‑Based Voices, a podcast from the Association for Value‑Based Cancer Care. Each episode dives into the shifting terrain of cancer care in the United States, exploring what value means today—from clinical policy to patient‑centered perspectives. Our mission is to spark informed conversations, dialogues, and promote transparency with every stakeholder, from providers to payers to patients with the insights we all need to navigate cancer care with clarity, confidence and purpose.

So let's get into it. I'm Burt Zweigenhaft, founder of the Association for Value‑Based Cancer Care and your host today. And with me is Liz Fowler, co‑founder and managing partner of Health Transformation Strategies. Today she’ll be discussing how she sees healthcare evolving in 2026. Welcome, Liz, and thanks for joining us. You have so much in your background that I could take half an hour just for an intro.

You’ve played major roles—from Director of the Innovation Center at CMS, to the Obama Administration and the ACA, and even back to MMA where you spent a lot of time advising. You’ve worked on both the commercial side with J\&J and the government side. Let me start by asking: What’s the difference between working in the healthcare industry, in the private sector and the public sector from your perspective?

[01:49] – LIZ:
Well, first, thanks for having me today. Always a pleasure to see you, Burt.

I would say it has been really insightful and informative to be both on the public side and the private side. Having worked in government you can help translate what is happening policy for private audiences and I think having that private experience gives you an understanding and appreciation for what regulation does and how it’s implemented and how it falls on private industry to think about implementation and what make it more feasible—and with as little hassle as possible.

[02:33] – BURT:
Yeah, it’s always a struggle to deal with; Legislation comes down, and Medicare or HHS has to implement sometimes some rough and conflicted policies. But they usually do a pretty good job and I know they get a lot of criticism but I’m going to complement them.

You and I were at J.P. Morgan last week. It kinds of marks for me—like many in healthcare—the start of the year. It’s the bell‑ringing moment: Where’s the smart dollars going? What policy changes are coming? Who’s got the latest innovations? So it’s always a good way to level set the year. From a government perspective, what were your impressions? How important is that “ringing of the bell” in healthcare at J.P. Morgan to you?

[03:45] – LIZ:
J.P. Morgan really sets the tone for what’s going to happen throughout the year—what to watch for, what’s the appetite for deals, where the dollars are flowing. And I think we saw that AI is still getting a lot of attention. There’s enthusiasm that maybe this is a positive year for dealmaking. And I also noticed, like you may have, last year we saw the pharmaceutical industry in the hot seat and clearly taking a lot incoming from the incoming government and policy officials and this year it feels like the insurers and health plans seem to be moving into the hot seat this year. The rhetoric coming out of Washington and you heard a bit of that at J. P. Morgan – the questioning of practices and the tension between payers and providers. I think we’ll see that throughout this year.

[04:51] – BURT:
Interesting you would call that out. Noticeably the Commercial health plans were not in attendance again this year and last year they weren’t and I think it’s because of some of the violence last year against healthcare leaders. But the government had a big presence: Dr. Oz, Chris Klopp, others. And that’s also unusual because I never remember seeing, in the 20 something years that I’ve been doing this, that many government speakers.

What was your take from talking to private investors and service providers? Are people looking at the government as leading the way? There’s a lot of uncertainty – that’s what I was hearing, what’s going to happen with reimbursement, Trump Rx, most‑favored nations, IRA, margin reductions?

[06:13] – LIZ:
Yes—that’s an interesting observation. I went to J.P. Morgan about 8 years ago and I was on a panel called, “What’s coming up in CMS,” and we followed a panel called, “What’s coming up at FDA.” The room was packed wall-to-wall for FDA and then when CMS came up the room emptied. That was a while ago. And there’s a lot more attention on CMS now and as you said, it had a big presence and major policy officials were there in addition to the administrator Dr. Oz, you also saw the head of Medicare – the head of the Innovation Center – Steph Carlton and Amy Gleeson and I think their message was that they wanted to hear from the private sector. They think there’s a lot going on and a lot worth hearing about and they wanted to hear from the people who attend J.P. Morgan. I think that’s an important signal that their listening and I’ve heard that theme echoed that that this administration is doing a good job of listening and hearing folks out and searching for new ideas.

[7:37] – BURT

So you say, “listening to the commercial markets,” but I almost feel, Liz, that the commercial markets are listening to the government.

All the uncertainty in the market is based on a lot of the new administrative initiatives -affordability, drug cost, site-of-care neutrality – if you’re a provider in cancer and you’re tied to the innovation and the cost of innovation. There’s a lot of talk of uncoupling that and the U.S. not paying the highest price in the world for drugs. We heard Dr. Oz and Chris and others talk about this. So is it more that the markets are going to follow the government versus the government trying to figure out what we should do and listen to markets?

[8:55] – LIZ

 I think everyone is still unpacking the most‑favored nation (MFN) proposals that came from the Innovation Center late last year—the Globe & Guard models, the Balance model for GLP‑1s, the Generous model for Medicaid. And I think there’s still a lot of sorting out what that means for the markets.

And all of that is on top of the IRA implementation, so trying to figure out what the interaction is among all these different piece. And I think there’s still unanswered questions and ultimately what the impact is going to be on what patients pay out of pocket. And then of course Congress is still debating PBM reform, which could be part of a deal … or not. We’ll see what happens in the next couple weeks.

This story is still being written and we’re all following it really closely.

[10:33] – BURT:
We did hear Dr. Oz say – and I’m not using his exact works - that the 17 companies that did some price negotiations on some GLP-1s and some other drugs aren’t necessarily safe from further concessions under IRA or MFN discussions. I think there’s a belief in the industry that if you negotiated with Trump and you gave him a win here you would be left alone on the backside. But it seems to be, based upon what Dr. Oz said, that this may not be the case. Do you any insights into that?

[11:09] – LIZ:
The MFN proposals are not finalized yet. And I suppose it’s like a sort of Damocles that if there are excess price increases, and there’s still uncertainty in the market, that maybe the final rule could be tougher than anticipated. So I don’t think we’ve seen the end of it.

But I do think companies have done a good job of responding to criticism and working with the administration to try to meet demands, but whether that’s enough remains to be seen.

[11:53] – BURT:
Let me throw out some quick ones. Site neutrality on reimbursement, do you think that’s addressed with this current administration? There’s been noise on that. What’s your opinion? What would you advise the industry? 

[12:14] – LIZ:
I think they’ve made strides. I mean look at their proposing to eliminate nearly 1,700–1,900 inpatient‑only codes that move things to the outpatient or ambulatory settings. I think they’ve signaled that they’re looking for other administrative means to address site neutrality. Congress is also showing bipartisan interest in addition to PBM reform. There’s till certainly activity that could happen in that space.

And ASP+6 continues to be a perpetual issue. And at the same time, there’s concern that the IRA may impact access if it’s not addressed on the physician side. You have lower prices, but the effectuation issue hasn’t been solved yet and needs to be addressed either by Congress or by the administration through some demonstration authority. There’s also concern about threats to access when Part B drugs are implemented. 

[13:28] – BURT:
There’s a lot of concern about Effectuation of Part B drugs and AVBCC has come up with 8 guiding principles by uniting wholesalers, providers, and drug manufacturers – well not perfectly aligned but we had to agree on a group on alignment – and we did make a recommendation to the industry on that.  

[13:46] – LIZ

What do you think is going to happen.

[13:48] – BURT

Well if you are going to have an MFN and you don’t have an ASP the whole industry gets reimbursed off ASP, and Barb McAneny the former president of the AMA has said community oncology is going to figure out they’re losing money long before the hospitals are going to figure out they’re losing money on this proposition and I think it could put the industry upside down and impact care. 

So I think we’ll work it out like most things – with dialogue and discussion.

Let’s move to 340B. I’ve heard John Brooks say during the October AVBCC meeting that he looks for maybe HRSA to no longer be the primary controller of 340B, it’s going to be CMS. What are we looking for, and what’s the government looking for in 340B reform. What do you think is going to happen there?

[15:03] – LIZ:
Yeah, what a sticky issue. 

Coming from J&J, from the pharma perspective, knowing that there’s access issues and probably important funding streams, but also just the market distortions caused by this policy. 

I don’t know how it will be resolved. I think you mentioned moving some of the HRSA responsibilities over to CMS. I think they’re still in the process of doing that. It still remains to be seen what that’s going to mean for future regulation and whether that regulation, or the new framework or changes, could be implemented. 

I imagine they’d be caught up in legal proceedings and lawsuits as they have in the past.

[16:05] – BURT:
Let’s hit our favorite topic: PBMs. Gross‑to‑net, rebate distortion—front and center. Where does this come out at the end of the day?

[16:22] – LIZ:
There’s bipartisan legislation on PBMs, this is one of the few areas where there seems to be some agreement and actually legislation drafted with the possibility of making it through to the finish line and getting signed by the President. 

Whether it is going to be a complete answer to some of these issues?  I’m not sure.

[16:54] – BURT:
Right—it always comes down to definitions. If transparency is required, PBMs may just rename rebates as “bona fide service fees.” And there’s been a lot of discussion around transparency and bona fide service fees. How do we avoid fixing one problem only to disguise it as another? Is that going to happen?

[17:40] – LIZ:
I think you’re raising an important point, unintended consequences and the need for Congress to monitor what’s happening when legislation is implemented. Unfortunately, because our politics have gotten so partisan and so divided, it makes it really hard to come up with that sort of mechanism for Congress to remain a good steward of all these programs. Legislation passes and then no one looks at it for another 10 to 15 years and then things have happened that they didn’t anticipate. 

Anything that they do there needs to be this constant oversight and monitory of what’s happening and making adjustments along the way. When legislation passes in a partisan maker, it makes it really hard because nobody wants to go back and reopen the legislation for fear that bad things could happen to undermine progress.  

So if there’s bipartisan legislation it offers the hope for continued oversight and stewardship of the legislation going forward.

[18:55] – BURT:
How much does the legislative side of our government communicate in advance with HHS. And who, to your point, is now reaching out and listening to commercial markets? How do we bring that conversation together so we don’t end up with bad legislation at the table?

[19:19] – LIZ:
Agencies routinely provide technical support for any legislation – what implementation would require, what it would look like to implement, is it written in the right way. So I think there is a process for Congress and the agency to communicate at the time something is being drafted. But you know, compromises happen, language changes, and implementation may not happen exactly as you anticipated. So even if there’s input on the front end, you still need that communication and ongoing collaboration. 

[20:02] – BURT:
So in closing, what would be your advice to industry leaders who need to work with policymakers, government agencies, and commercial markets. What’s your best advice? What should we be doing to better communicate or to be part of the conversation?

[20:32] – LIZ:
First of all, just being part of the conversation is really important. Our world is small and everyone knows each other. Build relationships early—don’t wait until you have an emergency or a crisis. Provide constructive input. Another piece of advice is to help government solve their stated problems, not just your own. That’s where mutually beneficial outcomes happen.

[21:19] – BURT:
Ok so look, you probably invented the term value‑based care

[21:33] – LIZ (laughing):
—that’s why I don’t want credit, But! No one knows what it is.

[21:36] – BURT:
Ok, fair. But what does it mean to you?

[21:39] – LIZ:
In my mind, it is an approach to delivering care and paying for care that is patient-centered, and team-based, where the incentives are aligned, and where outcomes are measured by quality and actual outputs, instead of a fee‑for‑service environment where it’s more about providing volume instead of value. 

[22:29] – BURT:
We’d be remiss not to talk about AI. I think AI is going to be the thing that really changes a lot of the game. What do you think would be the most monumental change that we could expect to see in the market.

[22:51] – LIZ:
You and I talked on the panel about how in healthcare there may be a new approach, new tech, new way of doing things that makes things more efficient in other sectors and somehow it drives up cost in the healthcare sector. So hopefully AI is something that can bring greater efficiency and hopefully lower costs and improved costs but never put it past the health system to figure out a way to capitalize and drive up costs instead. 

So the jury is still out. 

I think there’s great promise in what you can do. I know CMS is exploring creative and innovative ways to incorporate AI. And I think this administration is certainly looking for those pathways as well. Hopefully it results in greater efficiency and not greater cost. 

[23:44] – BURT:
Well thank you for spending a little bit of time with us and sharing your insights. I always say why is my car smarter than healthcare—but I think we’re going to get there I’m optimistic.

[24:05] – LIZ:
I’m always optimistic too. You have to be in this environment.

[24:14] – BURT:
We’ll see what the end‑of‑year interview looks like—what we got right and what came out of the serpent’s den. Thanks again, and God bless us all.

CLOSING

[24:29] – BURT:
This wraps up today’s episode of Value‑Based Voices, brought to you by the Association of Value‑Based Cancer Care. It's part of our community effort to ensure we improve access and quality and cost. Thank you to Liz Fowler for sharing her insights today and to you, our listeners, for joining in this conversation and listening. If you found today's discussion thought-provoking, be sure to subscribe to Value-Based Voices wherever you get your podcasts. 

Stay tuned for more episodes as me and others will spotlight the important issues before us every day as we shape and move through 2026. And more importantly, the future of cancer care.