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Making Patients the Center of U.S. Healthcare Reform · Making Medicine

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  You're listening to Making Medicine Stories from the Early Stage Life Sciences Ecosystem, a
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  podcast that explores the people and deals that have led to the medicines, devices,
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  and technologies that keep us healthy. Let's get into the show. Hello,
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  this is John Stanford, the host of the Making Medicine podcast. We're
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  thrilled to have McKay Jimison, executive director of the Patient Access and Affordability Project
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  at Patients Rising, with us today to talk about all things patients, all
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  things drug development, and of course all things policy. McKay, so glad
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  you could be here today to start off. You know, one of the
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  things we hear most from listeners is they're so keen to hear where people came
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  from and all the twisted and tortuous paths that led to a career in pharmaceutical
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  or life science. And you've had a little bit of both. Can you
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  talk a little bit about who you are and your history and how you ended
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  up running the Patient Access and Affordability Project. Yeah, thanks, John,
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  I appreciate you having me on. You know, I'm happy to talk a
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  little bit about my background. I view it as chapters, but at first
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  I just wanted thank you for having me on. I find America's really at
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  a crossroads when it comes to healthcare, and we need to have as may
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  people as possible talking about this conversation. And I just say that because I
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  didn't really start my career out in healthcare. I started out in politics,
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  like like many others. My first chapter was working for the Governor of Florida,
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  Jeff Bush, initially as a spokesperson as a speechwriter, and then later
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  on I wanted to have some business experience. I worked for some small companies
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  and then got back into into politics for a little bit. In the two
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  thousand and eight campaign, my candidate and win I needed a job and I
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  happened to find one at Visor, and I was just really fortunate. Visor
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  was looking for someone with a different experience than the kind of traditional healthcare pr
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  route. This was at the beginning of the Obamacare negotiations, and you know,
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  obviously the pharmaceutical industry has been under a pretty heavy political attack for for
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  years, and so it was a kind of a right fit, right time.
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  It really had a great run at Visor. That was the second chapter
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  of my career. I initially with a spokesperson for the company and then later
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  became the corporate affairs lead for one of Visor's businesses, their internal medicine business,
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  and it really gave me an incredible vantage point into all aspects of the
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  organization. When I initially got into Visor, I focused a lot on sort
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  of our late stage pipeline, and then as I progressed, had more experience
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  with some of the inline products. So I've covered everything from the earlier stage
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  science into the regular the tory issues, as well as once you get a
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  medicine on market, you know what are sort of the implications with access,
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  what are the implications with litigation in some cases, as well as what happens
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  when drug loses exclusivity. I've also had the opportunity to see manufacturing plants,
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  I've been in the labs where scientists work and discover drugs. I've also,
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  as part of my job, traveled all over the world talking with health ministers
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  or other officials and have had you know, really diverse experience learning how other
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  countries are really trying to solve their own healthcare crises. And so that kind
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  of inspired the third leg of my career, which is signed in now,
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  is really understanding how important it is that we redesign our system to center around
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  the patient first and foremost. I'm working now with an organization called Patients Rising.
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  At the core of Patients Rising, it's really always been about helping people
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  be their own best advocate in the healthcare system. We do a lot of
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  work with a university style program to help them become advocates as well as we
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  have a healthline that patients can call about really any need that they have and
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  we will help them get the resources or put them in touch with a network
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  of other organizations that can provide them the services that they need. So that's
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  the core of Patients Rising. And then kind of the book ends of that
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  is we have an advocacy organization or five one four called Patients Rising now.
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  And then what I lead is a little bit more of the policy arm we'd
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  like to We like to call it our think tank arm, though that might
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  be a bit grandiose, but it's the patient Access an Affordability project, and
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  it really is what it says. It's it's about access, affordability, transparency,
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  and equity. I always say our aim is to be the leading source
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  of patient inspired health policy. It's it's a job that I really have a
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  personal passion towards and have really enjoyed. We just brought together an advisory board
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  to help guide us in terms of looking ahead on our kind of strategic plan
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  for the future, both playing out a vision for what we want the patient
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  access an affordability project to become, but also what's our vision for healthcare,
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  what does America need as relates to maintaining leadership in science and innovation, but
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  also how do we think about financing healthcare to keep up with the pace of
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  science and medical innovation that we see well, And I think that's what we're
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  going to spend so much of today's episode unpacking, because, as we're going
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  to talk about in a second, you made some very good and public points
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  about you can't have it all to some extent, and so you know,
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  I think that's a fascinating sort of background you had from politics into healthcare.
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  Then just as deep expertise that develops because you know, Fizer, if you
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  talk about sort of someone with a big enough footprint that you would be seeing
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  health ministers, but also seeing labs, but also seeing manufacturing, you know
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  a little bit of exposure to everything, and I think that that gives you
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  a really good lens for what you're trying to do now. And I think
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  where incubating patients rising definitely overlap is this idea of patient centricity. And I
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  think, in a nutshell from incubates perspective, patient centricity is going to require
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  choice and if we if we make some decisions, if we go down some
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  paths that are being discussed, that limit innovation. The other way I think
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  about it is Okay, you're giving patients fewer choices. So one of ourbc's
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  always puts it to me, well, you know, hip replacement is a
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  terribly painful surgery and enormously expensive, but if you need it, you go
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  get it. In ten years from now, we should be taking some sort
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  of pill that alleviates that. And maybe we have no hip replacements because medicine
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  is doing the job that the surgery has been doing. And when I think
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  about patient centricity, you can't have the patient at the center if there are
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  no choices. So I don't care how cheap we make hip replacements, or
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  you're still going to have to go to the hospital. You're still gonna have
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  to have your hip replaced. And I think sometimes people don't think about innovation
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  as a patient choice aspect. They think about it from the science perspective or
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  the cost perspective. But you know, I wonder if you have any reaction
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  to that is, to some extent, empowering the patient gonna require more choices
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  for the patient about how they want to address their particular therapeutic need. Choices,
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  transparent see access to information. I think are all going to be critical
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  elements. You know. One of the things that really frustrates me. I
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  hear all the time that patients things are too sophisticate for patients, or patients
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  don't have an interest in X, Y and z. My experience is the
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  complete opposite. Now, you may have varying degrees of sophistication based off of,
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  you know, a patient maybe just being diagnosed versus you know, a
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  patient who's been dealing with a disease for a very long time. But my
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  experience is there's a hunger for patients to understand what's going on in the healthcare
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  system. They want to be actively engaged. They know they have to be
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  their self advocate, especially now we're seeing the erosion of the patient doctor relationship
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  and the power being now put in the hands of really large companies or the
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  government to decide what's best for them. The interesting thing on the hip replacement
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  thing is when it comes to comes to cost, a lot of times you're
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  not even seeing real competition as it relates to uh, those procedures. And
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  UM, I'm aware of of of a startup that's doing some really great work
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  in almost doing an Expedia style or an Airbnb style model where you can do
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  procedures. Um, you can you can ask the hospital systems to compete for
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  procedures. Uh. This business is getting procedures done at a lower cost than
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  the rebated rates that the insurers are getting. Uh. That's an example of
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  where I think you have entrepreneurs uh, you know, where you have investors
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  behind really innovative solutions. But the reason nobody's heard of this company is because
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  it's a threat to the health systems. It's a threat to the consolidated powers
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  that kind of exist. And so that's one of the biggest things that I
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  think we really have to tackle is to make meaningful change in the healthcare system
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  to provide the type of choice to center things around patients is going to take
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  I think a unwinding of a very entangled system of self interests. Of some
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  very large, um large large organizations. Yeah, I think you're I feel
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  like the discussion of that unwinding is is fodder for dozens more episodes because I
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  think you're exact. I think it bears saying that our system right now is
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  not patient centered um our pay. I would I would even say it was
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  never it was never designed to be patient centric. And I think this is
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  this is one of the biggest challenges that we really have, is we can't
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  go back in time. We can only go forward. But to go forward,
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  it's can probably require some difficult choices that counter you know, some longstanding
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  business interests. And you know, when when you think about really our our
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  modern healthcare or modern health insurance system, it was really built around uh the
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  nineteen forties, you know, response to inflation at that point in time in
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  wage controls, and uh, you know what what had what happened was rather
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  than offering increased wages, employers started to offer health insurance as a way to
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  make to compete for employees, which then set off Blue Cross and Blue Shield
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  to design products cater to employers and later the government. And really, when
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  you think about it, the product has always been the payer it's always been
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  the employer or the government. The product has never been centered towards the actual
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  patient itself, And so we have to unravel almost one hundred years of a
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  system that's been built up, but it was never centered around the patient.
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  You know, I think that's something we all should dwell on for a second,
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  that the patient has never been at the center of our healthcare system.
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  And so I think that's why a lot of the work that you do is
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  so important. And I also completely agree about this the way we talk about
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  patients and we talk about their literacy rates as it relates to a therapeutic area.
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  I don't think you can see a better informed group than a set of
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  patients or parents of patients pouring over NIH studies and anxiously awaiting Phase two and
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  Phase three A and B results. So I think this idea that patients can't
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  follow what's going on in healthcare is completely contradictory, because it's in your self
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  interest to understand your disease and the options that are out there. But it
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  is so hard. And Hearson access in and I know, you know,
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  has been on talking about clinical trial access and making that more available, and
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  I think that's another component to allow people to know if clinical trials can have
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  a place their particular therapy. No, I was gonna say, actually,
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  I do think clinical trials that that's another area where I'm seeing a lot of
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  investment as well as a lot of entrepreneurial thinking. Um, I'm you know,
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  a company that I'm familiar with as well has really rethought even how you
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  do patient recruitment. Rather than you know, everything's always been these big advertising
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  campaigns, you know, bus ads and you know whatever else, and it's
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  never really been particularly effective. This particular company's changed it where they're integrated into
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  health systems EMRs and they're able to identify, qualify patients and use their their
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  actual treating physician as as someone who can offer them a clinical trial as a
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  treatment option, which makes a ton of sense. And so rather than having
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  to revolve around academic medical centers, we're actually touching patients at the actual point
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  of and their their success rate in terms of recruiting patients that are actually qualified
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  meeting they meet the criteria set forth in the clinical trials is astronomical. It's
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  a game change. Yeah, I think the democratization of clinical trials is it's
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  kind of have you have two sides who need to find each other, and
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  we had just designed a system that didn't let them find each other. But
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  of course the simplest thing to do is go get that trusted guidance from the
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  doctor. So I'm sure the startups in these spaces are going to see some
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  breakthroughs. I want to pivot to the original reason for having you on,
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  because you know, for many of our our listeners, we've got a lot
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  of policymakers and their and their staffs who listen. You wrote a pretty compelling
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  piece in my view in stat following the State of the Union, and it
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  put voice to something that that was really on my mind that night as well.
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  And for those of you who haven't seen it, will make sure we
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  attach it in in the podcast notes. But it's a great article and it
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  looks at two sentences in the State of the Union, the first one being
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  President Biden's announcement that at long last, he and Democrats in Congress have reined
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  in drug prices through the Inflation Reduction Act. And we've talked a lot about
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  on this show about the impact of price controls on investment. But then forty
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  minutes later in the speech. He talks about that under the Biden administration,
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  they're launching a moonshot that's going to tackle cancer. And you wrote a piece
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  saying these two sentences are fundamentally at odds and that they were spaced out in
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  the speech so that you forgot that one was said related to the other.
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  Can you just talk a little bit more about your thinking that you you opined
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  and in that OpenD that I just thought was great. Yeah, thank you
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  for that. So this is something that's really been of a concern to me
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  ever since, you know, President Biden was was elected, because he's he's
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  talked quite a bit even during the campaign about looking to more of a European
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  style system for managing you know, healthcare expenses, and you know, the
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  Inflation Reduction Act has really been a significant step in that direction. And I
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  should just say just my background, Um, I lived in Europe as well
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  as Canada in my childhood. My mom, when I was in college at
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  this point, had a disease. Uh, she's okay now, but while
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  they were living in Europe and had to move back to the States. I
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  know a lot of people love how Europe operates healthcare. I've had my experiences
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  with it. My family's had were experiences. We've moved back to the States
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  and lived here for a reason. But all that said, we're in a
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  place where we have, I think, very contradictory notions about the state of
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  healthcare. In one, there's a desire to reign in cost, and I
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  think that, you know what, I think that's not a wrong desire,
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  right, we shouldn't have wasteful spending. But but there's definitely this politicization of
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  healthcare and particularly the pharmaceutical industry. When you look at it, you know,
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  and it's a declining spend year over year. Now it is a significant
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  spend, but we're we're ignoring roughly ninety two percent of the overall costs in
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  the healthcare system. But this idea that on one end we can have a
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  moonshot to address cancer and then on the other end be saying that if you
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  are successful at developing new treatments, we're not, We're going to take away
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  the original incentive that existed. Those two policies are incompatible, right, and
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  so it's a concern that I think, listen, State of the Union's you
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  know, there's some poll tested rhetoric without a doubt. But if you're a
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  speech writer, you know how this goes. But but we're but we're going
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  a little bit big beyond the rhetoric, I think with the policy that we're
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  seeing and now that now that we see what CMS is doing as it relates
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  to both the Inflation Reduction Act, but also as it relates to how they're
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  starting to look at accelerated approval drugs, not just in Alzheimer's, by the
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  way, expanding beyond to look at selling gene therapy, immunology, other areas
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  where there's tremendous promise and science. We're moving to an area where we have
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  an incredibly contradictory approach with even within our own government. You know, I
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  actually wrote a piece recently called that we have a cold war within HHS where
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  you have the FDA. And I've been very critical of the FDA historically,
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  but I will say I think they're moving in the right direction in any ways
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  and trying to accelerate new medicines to patients where there's just a substantial need.
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  And listen, there may be some controversial decisions that are made along the way,
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  but I think as long as we're being evidence based, we're developing evidence
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  over time, the right answer will come forward and we'll understand that. And
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  trust me, these patients are desperate for medicines. We shouldn't hold them back
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  from them. But then on the other end, you have the payer side
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  of the system that says, we're distrusting of that FDA's approval. We're just
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  we don't know how to deal with this what they deem a low level of
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  evidence, and so they're moving towards this path of choosing not to cover these
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  medicines for these patients. This is, you know, particularly when you look
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  at a disease area like Alzheimer's, which disproportionately touch as seniors. This is
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  medicare saying to the population that they serve, we're not looking out for your
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  interests. To me, that is frightening. That is frightening. Yeah,
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  I think, And you know, if you put our put incubates hat on
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  of being the investor, it's frightening too, because our investments are ten years
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  out, fifteen years out. The dollars we invest today hopefully bring forward a
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  medicine in ten years. So if we show that only works, if we
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  know that in twenty thirty three, the reimbursement system in the United States.
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  It looks something like it looked like in twenty twenty three, and we're starting
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  to see more coverage and more discussion. But I'm with you. We've got
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  the bucket of problems that the Inflation Reduction Act caused. We've got the small
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  molecule penalty. We haven't really solved and I want to come back to this.
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  We haven't really solved access and affordability issues. We just made ourselves feel
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  better for a second. There are some good pro patient reforms. We like
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  patients moving, we like capping out of pocket costs. These are things Incubate
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  fights for. But we've also got over here, which you've just touched on,
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  and this idea that FDA approval is no longer the stamp that it used
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  to be on a product, and payers are second guessing in this case CMS.
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  That's a dangerous, dangerous place to be. And at first it was,
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  well, it's just Alzheimer's. Because of the data and because it's going
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  to be so expensive. These tools and you know this as a product of
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  not just policy but politics. Once you create a tool in the toolkit,
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  you don't put it away. You keep finding other reasons to use that tool,
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  and these non coverage decisions seem to now be cms's tool to say,
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  well, you convince the FDA, but we're not convinced. And that's a
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  bifurcated system that patients can afford. And it's not scientific, it's ideological.
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  There's this piece that was actually published in one of the medical journals yesterday from
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  some of the folks at Harvard, and they cherry picked three countries. They
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  looked at France, Germany, and Canada, and they decided that basically nearly
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  all of the medicines that the top medicines in medicare basically should not be prescribed
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  to patients because they don't they they're not significant enough in their in their value.
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  Now, none of those countries ask the patient how valuable those medicines are
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  to them. But that's the system that people are envisioning. They want to
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  put the power in the hands of health economists to determine whether or not something
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  is of value to the system. And they're looking at it again from the
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  payer perspective, from the health system's perspective, which means that they're not if
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  you have, if you have a medicine that helps you go back to work,
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  increases your productivity. And this is where it really gets crazy. That's
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  actually in the employer's interests, right, But the health and the way that
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  they're designing their benefits programs, um, they're not. They're not capturing productivity
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  as a benefit to them. And so even though it's even in the employer's
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  interest, it's not going to necessarily be reflected in how the insurance design covers
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  it because fundamentally they're focused on costing the existing system that they're captured, not
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  indirect medical costs, not things related to economic benefit. Being able to continue
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  in education, you know, be able to take care of your children,
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  for example, all sorts of societal benefits that are of extreme value. It
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  could be, and it could be as simple as not even going back to
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  work. But um, you know, I heard a story of a medicine
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  in a rare disease space where one of them things that was learned through the
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  clinical trial process was just for that medicine to give a patient the ability to
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  move their finger so that they could operate a wheelchair was a game changer for
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  them. Now, from health to this perspective, that may not be substantial
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  value, but to that patient. It's a game changer. It's a game
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  changer. And so the biggest concern to me is when all these CMS policies
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  are made, who's asking the patient what they think? Right? Instead,
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  it's just using some algorithms to model out some kind of cost benefit analysis rather
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  than understanding the true human impact associated with particular medicine. Well, and I
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  think even some supporters of the Inflation Reduction Act as the you know, we
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  said, look, the devil's going to be in the details here. It's
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  one thing to say, okay, we're ushering in an air of price controls.
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  Okay, how are you going to set the price? In this initial
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  CMS guidance Incubate filed some comments on but a lot of the patient community and
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  Congress by some extent have now started talking about qualities these adjusted life years,
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  and even some of the most ardent supporters of the Inflation Reduction Act are saying,
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  no, no, we're not for Quale's but okay, you're it gets
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  to your words sort of incompatible policies. Okay, Well, at some point
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  you're letting a health economist or someone at CMS begin to be determining value without
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  the patient voice and I know the patient community has been very concerned about not
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  having a seat at the table as these price controls are developed, because that's
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  something Patient Rising or your project at Access and Affordability Project have been looking at.
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  Yeah, in fact, we've been tip of the spears. It relates
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  to really calling a question of the use of the quality, really questioning iser's
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  of methodology. We do believe it's inherently discriminatory. It isn't. It is
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  an outdated method. It was designed before I was born. Um, you
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  know, I try to assume best intent and I'm assuming that it was probably
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  fit for purpose in the nineteen sixties and seventies, but in the twenty first
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  centuries completely outdated. But there's this is part of sort of this ideological,
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  you know system that there are people believe that this is the standard that we
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  have, this is good enough. And the funny thing is it's the same
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  people are saying that the medicines that are being approofed today are not innovative enough,
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  that are unwilling to say that how they're measuring value needs to be adjusted
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  because times are changed, right, I'm like it's a bit of a double
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  standard. Folks, Like, like the reality is we should expect medicines to
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  improve and increase value to patients over time. That's a legitimate expectation, and
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  manufacturers should be expected to demonstrate that evidence as well. And every manufacturer I
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  speak to say, we're happy to try to show the evidence. But then
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  you have these health economists that are like, well, we've been using the
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  quality for forty years. It's the gold standards. We don't need to change
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  it. It's the gold standard. No. Medicine has evolved, science has
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  evolved. We're now in the state where we can capture things in an incredibly
• 27:06
  more granular way using technology, and there's this complete unwillingness to move away from
• 27:14
  it. Fortunately, you're right. Members of Congress are also many are deeply
• 27:18
  concerned about the use of Quality. There's a reason why it was banned as
• 27:22
  it relates to making access decisions for Medicare, and it does seem like we're
• 27:27
  moving in the direction like it will not be used for negotiations. That said,
• 27:32
  there's also other measures that are not great that other European governments used that
• 27:37
  I do think that we should be keeping an eye on as well. It's
• 27:41
  hard to call out which one because we don't know what CMS is looking at
• 27:45
  right now. But I think the bigger point is that there needs to be
• 27:49
  more of an effort at encouraging academics, economists, the private sector, etc.
• 27:59
  To be thinking about what is the right way to be valuing new health
• 28:03
  technologies? What is the best process? There shouldn't be a monopoly on there's
• 28:06
  no ice, or should not be a monopoly on health technology assessment. The
• 28:08
  federal government should not be a monopoly on health technology assessment. We should encourage
• 28:14
  people who probably don't reside in Washington, DC to start putting forward one hundred
• 28:18
  different ideas because on a hundred different ideas, we build a hundred different results,
• 28:22
  and we will start to have a dialogue on what is the best way
• 28:25
  to value it. I personally I am not going to be able to do
• 28:29
  it. You probably can't do it, but collectively we can. At least
• 28:33
  we can have a competition of ideas and discussion rather than just saying you know,
• 28:37
  no, it's the status quo or some augmented version of that. Well,
• 28:41
  what I think you're spot on there, and I think everyone heard it
• 28:45
  here first to call an open call for HTA ideas of that actually take into
• 28:52
  account the modern lifestyle. You know, I remember years ago one of the
• 28:56
  rheumatory arthritis products was going going from an injectable to an oral, going from
• 29:03
  an infusion therapy to an oral pill, and a lot of people said,
• 29:07
  well, that's not that innovative. Well tell that to the patient. Tell
• 29:11
  that to the patient who's comfortable taking a pill at work but not comfortable doing
• 29:15
  infusion or just the ease of not going to the clinic. So I think,
• 29:21
  what is innovation? Leaving the patient's voice out and turning this into a
• 29:27
  philosophical economics argument at a college campus really leaves out all of us because we're
• 29:34
  all going to be patients someday. We all want to walk more, we
• 29:37
  want to we want to be healthier. Um, what what else I'll close
• 29:42
  with here? I'm so grateful for the time you spent with us today.
• 29:45
  Um, what can incubates listeners expect out of your project and patient rising in
• 29:52
  the months and years to come? Yeah? No, thanks for that.
• 29:55
  So for twenty twenty three, you know, we're really focused on and full
• 30:00
  of areas we're Actually we did some really important work last year as it relates
• 30:04
  to health technology assessment for rare disease therapies. We're going to build off of
• 30:10
  that LATH this year, and I actually think it's it's more relevant than I
• 30:14
  ever expected because of the issues with accelerated approval. Based off of the debate
• 30:19
  that we're seeing, there needs to be stronger guidance on how to collect evidence
• 30:25
  over time to demonstrate value. As it relates to these accelerated approval drugs.
• 30:30
  We can't just say you can't have them because they haven't received full approval.
• 30:33
  It's just fundamentally wrong and unethical. So that's a major area of focus for
• 30:38
  us. Another area that we're going to be focusing on as well is there's
• 30:45
  still a lot of issues as it relates to PBMs formularity designs, both in
• 30:51
  the branded space with things like copae accumulators and maximizers which are just basically just
• 30:57
  killing patients as relates out of pocket costs, but also it's killing our generics
• 31:03
  and buy a similars markets. As it relates to competition, we need effective
• 31:07
  and competitive by a similar markets to drive down lower costs, and people will
• 31:11
  be surprised that the PBMs and the GPOs are actually standing in the way of
• 31:15
  competition. And then another area that we're going to continue to focus on is
• 31:21
  I think, really I call it patient transparency, but it's really focused on
• 31:26
  the lack of transparency within the healthcare system that patients deserve to have a better
• 31:32
  right to know on We're currently working on strategic planning process as well. As
• 31:36
  we go forward in twenty twenty four and beyond, I think we're looking to
• 31:40
  be more provocative and more disruptive. The biggest question on my mind that we
• 31:45
  want to dig into is really the question around healthcare finance. How we did
• 31:51
  it in the mid twentieth century is not how we need to be doing it
• 31:53
  in the twenty first century, and so how do we change, How do
• 31:57
  we move the way that we finance healthcare in a way that reflects advances in
• 32:01
  science and medicine. Number one. Number two will continue to have like a
• 32:06
  keen eye on rare disease, particularly ultrarare disease, but also the reality is
• 32:13
  NERD degenerate diseases and OBAC related metabolic diseases are the epidemics of our generation.
• 32:19
  We need to get a handle on how we are going to address that all
• 32:22
  across the health system, and that's going to involve innovators and science and medicine.
• 32:27
  That's going to involve financing how we finance it, but that's also going
• 32:31
  to deal with care and thinking about that in an optimal way that enhances human
• 32:37
  life, but also make sure that we're not we're able to afford these things
• 32:39
  as well. It's incredibly expensive area. And then the third area that I'm
• 32:43
  really excited about is really looking at the application of digital health, looking at
• 32:46
  everything from patient privacy, who should own patient data? I'm actually going to
• 32:52
  argue it should be the patient, and we have the ability to do this
• 32:55
  through blockchain as opposed to third parties, as well as a you know,
• 33:01
  with the role of AI and decision making. You know, this is an
• 33:05
  area that's really of concern to me, particularly as you see this consolidation ship
• 33:07
  and a power among like CBS is a great example. How is the AI
• 33:14
  going to be used? But also the positives of digital you know, how
• 33:15
  can they enhance life, how can they improve drug development, how can they
• 33:19
  improve the way that we care for patients along the way. So those are
• 33:22
  three ambitious areas, but that's what we're really excited to be digging into going
• 33:28
  forward. That is a full agenda, But I also love where I think
• 33:30
  we're gonna have to have you back on because I a whole other episode of
• 33:36
  how will chat GPT change the patient experience? So I'm going to give you
• 33:40
  the homework of solving that question. But that's a that's a full agenda,
• 33:45
  and you can keep up with McKay's work by following the Patient Access and Affordability
• 33:52
  Project at Patients Rising, where he is executive director. He is McKay Jimison.
• 33:59
  We're so grateful that you were able to join the conversation for one of
• 34:02
  our more patient forward episodes, which I've really appreciated, So thank you again
• 34:07
  for joining. I am John Stanford. You can find this the Making Medicine
• 34:12
  podcast and so much more at Incubate Coalition dot org. Many thanks to Ashland
• 34:17
  Roberts and Grace Muster in production of today's episode, and as always, keep
• 34:23
  innovating. You've been listening to Making Medicine. To ensure that you never miss
• 34:29
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