Session VIII — CEO Perspectives
The Industry Is At a Crossroads
Three CEOs — Ashley Magargee (Genentech), Brett Monia (Ionis), Bob Bradway (Amgen) — on policy threats, healthcare costs, and industry advocacy. Moderated by Karen Akinsanya.
The System, Not the Drug, Is the Cost Problem
- Drug spend is ~10% of US healthcare (was 12% when Magargee was born); 93% by spend is generic/biosimilar
- $500–800B/year in US administrative overhead (PBMs, prior auth) — multiples of entire pharma revenue
- Genentech piloted a transparent PBM for employees: $70M savings over 3 years, reinvested in R&D
The IRA Threat
- Shortens exclusivity windows for small molecules → kills the development arc from late-line to cure
- Capital will exit small molecule oncology; damage visible a decade from now
China Competition
- China relaxing regulatory constraints to accelerate into the clinic
- US built this industry; competitors intend to build on what the US built
- “We are at a crossroads” — Monia
Industry Must Become Its Own Advocate
- “We don’t tell the story effectively enough” — Monia
- Narrative is now a core competency — if industry doesn’t tell its story, misinformation fills the void
- Companies must demonstrate medicines are a good investment for society, not just safe and efficacious
Managing Bias
- Bradway recommends Kahneman/Tversky as structural check on cognition
- Culture and transparency beat hierarchy — the data must win
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