Untangling the IRA with Emma Cousin

🎧 Hosts: Na-Ri Oh & Ian Wendt
🎓 Special Guests: Emma Cousin (PhD Candidate, Choice Institute – UW), Amos Fung (RealPharma Intern & Student Pharmacist)

In this thought-provoking episode, hosts Na-Ri Oh and Ian Wendt sit down with Emma Cousin, a PhD candidate at the Choice Institute, University of Washington, to unpack the real-world implications of the Inflation Reduction Act (IRA)—particularly the Medicare Drug Price Negotiation Program.

Joining them is Amos Fung, a RealPharma intern who brings a front-line pharmacy perspective to the policy conversation.

Together, they discuss:

• 📜 A primer on the IRA’s healthcare provisions—what it is, how it came to be, and why it matters now.

• 💊 How CMS selects drugs for Medicare negotiation and whether this process constitutes true “negotiation.”

• 👩‍⚕️ The ripple effects on pharmacists, pharmacies, and patient care.

• 💸 The looming concerns around cashflow, operational readiness, and access as the 2026 implementation date approaches.

• 🧠 How researchers like Emma are modeling long-term effects—and what metrics we’ll need to track to assess the IRA’s success.

• 🔄 Unintended consequences and who might be left behind—especially independent pharmacies and vulnerable communities.

• 📈 A candid discussion on myths around drug pricing and why “good intentions” in policy still need strong evidence and thoughtful execution.

• The IRA marks the first time Medicare can directly negotiate drug prices—albeit in a tightly structured format that raises questions about the fairness of “negotiation.”

• Pharmacies face operational and financial strain, particularly smaller or independent ones, due to rebate lags and implementation complexities.

• Patients will benefit from caps on out-of-pocket costs, but awareness and education are lacking—many don’t realize what the law offers.

• Stakeholders like pharmacists, researchers, and policy influencers need better communication and clearer technical standards from CMS.

• Evidence-based policy should be the north star for drug pricing reforms, but real-world implementation remains messy and evolving.

• Brian Reid & Adam Fein – Top newsletters to follow for updates on drug pricing policy.

• CMS Guidance Documents – Frequently updated, but often inaccessible to non-policy experts.

• National Pharmaceutical Council, Milliman, Portal (Harvard) – Organizations doing forward-looking modeling and policy impact research.