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MUSING

Musing on PhRMA’s take and the TAM for drug development

PhRMA, the trade association for the pharmaceutical industry, shared a fascinating white paper this week highlighting the accessibility of new drugs across various countries while making the case that MFN pricing in the US is a bad idea. The chart they put together to highlight the argument makes for a nice visual, showing how the US has access to 88% of new drugs, which is roughly double that of other countries:

Source: PhRMA white paper

Now, I’m not sure about you, but I look at that chart, and it’s pretty clear to me which healthcare system I’d prefer, at least on this metric: the one with access to new innovative medicines. Of course, this is where we get into the tangled web of trade-offs, and specifically, how we manage the costs of those new medicines. PhRMA is talking about this topic because it is fighting against MFN pricing, arguing that the US risks losing access to life-saving medicines by pricing them more like other countries, as evidenced in the chart above.

While PhRMA feels like it is in the defining battle of its time, the tech community is over on X drooling about the TAM opportunity of developing new drugs. It’s an interesting sentiment I see more and more of these days, specifically folks ogling over the annual revenue of blockbuster drugs like Keytruda when compared to the AI labs AI-enabled consultancies:

I generally agree with the underlying sentiment that Asparouhov expresses in the TBPN clip above: capital is rotating into pharma, given the opportunity presented by AI to accelerate the development of new drugs. More and more conversations I have with healthcare services investors seem to be moving in this direction — even if you’re not investing directly in life sciences, you’re probably looking at investing in life sciences infrastructure/enablement as a derivative play. As evidence of this, check out three of the largest funding rounds this week (Forus, BranchLab, and Tokaido).

I find it fascinating to juxtapose the PhRMA chart above with the entrepreneurial viewpoint on pharma. On the one hand, we have entrepreneurs talking about how the TAM for developing new drugs is larger than that of the AI labs. It feels a lot like the energy from the tech community around digital health / virtual care back in the frothy-ZIRP days — heady ideas of changing healthcare in this country, attracting tech talent with the expectation of doing well financially while solving an intractable problem. On the other hand, we have the association of drug makers essentially fighting to keep that TAM afloat while the country balks at the prices we are paying for these drugs. Ultimately, it seems like a good thing to me that we have our best and brightest folks working on problems like curing cancer, and whatnot. I also think the expectation of a financial outcome is part and parcel of that occurring. And therein lies the tradeoff.

In many ways, the questions about how we fund the development of and pay for access to pharmaceutical innovation feel like the defining questions for healthcare in this country going forward. The iron triangle, as always, provides a helpful lens on how this may play out. For instance, if you assume costs can’t just keep going up, and also that no politician is going to want to slow down pharmaceutical innovation, the inevitable answer is that access to new drugs will go down.

Q1 EARNINGS WRAP-UP

Earnings season slows down with some major misses

A few stragglers reported earnings this week, but they actually provided three rather interesting strategic updates on different narratives across healthcare, from the D2C longevity play (Hims), to the AI for healthcare enterprises play (Health Catalyst), to the pharma advertising to doctors play (Doximity). All three saw their stock prices sink 10+% on the week as each gave investors some idiosyncratic causes for concern on each of their businesses. Let’s dive in:

  • Hims & Hers stock dropped 14% this week on a mixed earnings report that saw Hims raise revenue guidance while simultaneously lowering EBITDA guidance for 2026. The quarter also brought $28 million in restructuring costs due to its pivot from compounded GLP-1s to branded GLP-1s via its now on-again partnership with Novo. Hims noted in Q&A that the unit economics of a customer on a branded product versus a compounded product are “roughly comparable,” which on its face doesn’t make a ton of sense to me. Hims seems to view its long-term targets ($6.5+ billion in revenue and $1.3+ billion in Adj EBITDA by 2030) as intact despite the near-term chopiness.

  • Health Catalyst is down ~20% on the week despite revenue and Adjusted EBITDA coming in ahead of guidance. It is currently trading at a market cap of only $88 million, as the earnings call highlighted the massive strategic pivot underway for HCAT as it transitions from a legacy platform that provided infrastructure to a new AI-centric application offering. HCAT has $52 million in revenue at risk during the transition as clients move to their own infrastructure, but it still expects to retain most of its clients as customers of its new application layer. Will be worth keeping an eye on what happens to HCAT from here.

  • Doximity’s stock was hammered this week after reporting Q4 2026 earnings. It dropped 28% as it reported a soft pharma ad market and declining margins due to increased investments in AI. Gross margins fell 2%, while Adj EBITDA margins fell 5% YoY because of the increased spending on AI. Nonetheless, Doximity seems confident in the AI play, noting it is a multi-billion-dollar new TAM for the company as it enters the provider “paid search” market, at one point suggesting that AI will be like what Google did to the Yellow Pages. Worth noting that while the stock fell sharply, Doximity still generated 45% Adj EBITDA margins and $107 million of free cash flow in the quarter.

    • As an aside, Doximity is now worth ~30% of what OpenEvidence is while generating as much free cash flow in the quarter as OpenEvidence generated in revenue in 2025. I get that the private markets and public markets value things differently, but that just seems silly to me. One of those two valuations seems off.

Check out our other earnings coverage in the Slack discussion here, as well as Martin’s coverage of public company presentations at BofA during the week.

CHART OF THE WEEK

Healthcare: America’s Jobs Program

Bijan Salehizadeh made this point on X this week, highlighting the data from this WSJ post on the most recent jobs report. I think it is an interesting thought exercise to consider the healthcare industry as primarily a jobs program for the country, and the downstream implications of that. If we’re serious about reducing healthcare costs as a % of GDP, I can tell you where I think those savings would come from, and I’m not sure anyone wants to deal with the fallout of skyrocketing unemployment.

A QUOTE TO PONDER

Digital health pushes back on ACCESS

Both Endpoints and Stat featured perspectives on ACCESS this week from digital health stalwarts, suggesting that the program is missing the mark. Hinge Health’s CEO Daniel Perez issued the most direct public rebuke of the program I’ve seen to date, telling Stat:

It will not improve outcomes, it will not improve the experience, and it will most certainly not reduce costs. And the way it’s been structured, digital health companies have to basically remove any sort of clinical human oversight.

Source: Hinge Health CEO Daniel Perez; Stat News quote

I will say, if there were a prediction market on ACCESS, I’d guess Perez’s suggestion above would be the likely outcome. Given the general trajectory of American healthcare, that always seems like a safe bet to make. Heck, given the current state of healthcare, I think you could make the same general argument about the impact the digital health industry has had writ large since it boomed over the last decade. Such is the nature of these things.

That said, I imagine CMMI and the 150+ companies participating in ACCESS feel differently about it being a foregone conclusion that ACCESS will not improve outcomes, experience, or reduce costs. It’s why I find ACCESS to be such an interesting experiment — regardless of whether it is ultimately successful, I think it is a good thing that we have regulators pushing on these fronts.

Other Top Headlines

  • OpenAI launched the OpenAI Deployment Company this week, joining Anthropic in launching a consulting firm that uses "Forward Deployed Engineers” to help enterprises adopt AI tools. Nineteen investment firms and consultancies have agreed to participate, a number of which have healthcare-related investments, including Welsh Carson. If I’m confident of one outcome of everything happening in AI, it’s that we’re entering a golden age for consulting. Keep in mind that the most tangible impact of AI on healthcare public earnings results over the last few weeks was Doximity's stock plummeting 30% as its EBITDA margin dropped 5% due to AI compute costs. I can see why the big labs are racing to bring in the consultants Forward Deployed Engineers here.

  • OptumRx is moving to a more transparent PBM pricing structure, offering clients a fee-based model that provides visibility into OptumRx’s fees, including those associated with its GPO. It seems like a logical move given the current state of the market.

  • Function acquired SuppCo, a startup offering a personalized supplement “stack”, for an undisclosed amount. SuppCo had previously raised $5.5 million in Seed financing from Union Square Ventures and others, and this thesis from USV at the time is worth checking out. It does a nice job getting at the heart of the bull case for the longevity market, centered around building a new healthcare system. I remain deeply skeptical of this vision playing out, but I would happily be wrong here.

  • Mass General Brigham was in the news again this week as the Boston Globe highlighted its effort to launch virtual visits via a partnership with K Health. Since launching in September, the service has seen over 14,000 virtual visits and appears to be well-received by patients. MGB primary care providers remain unhappy with the effort, suggesting MGB should instead invest in primary care. One week, MGB is getting hammered by the Massachusetts Health Policy Commission for increasing costs by adding access to primary care, the next, its own primary care providers are critiquing it for investing in a service that provides access to cheap visits instead of investing in the providers. It’s not all too often that I am sympathetic to the plight of academic medical centers, but I’m not sure what else we want MGB to be doing here?

  • Hippocratic AI responded publicly to Sergei Polevikov’s series of over-the-top critiques against the company. Once you get past the interpersonal drama, Hippocratic’s response had some interesting data points on the current state of the business — it is seemingly generating almost $5 million in revenue a month today while burning $3 million in cash a month. Based on the data provided, it would seem Hippocratic did at most $20 million of revenue in 2025, putting its $3.5 billion Series C valuation at a 150x trailing revenue multiple in November 2025.

  • OpenEvidence was featured in NBC News this week, with the report noting that it now has 650,000 US physicians actively using the platform and that it had 27 million searches in April 2026. Perhaps the most interesting note in the article was how NBC News noted that the doctors it talked to said that ads on OpenEvidence were “either unobtrusive or nonexistent.” Pairing that with the Doximity notes above about the softness of the pharma advertising market, and it’s interesting to think about the implications for the model.

  • CMS continues its push against fraud, waste, and abuse in healthcare across multiple fronts. On Wednesday, CMS announced a six-month moratorium for new hospice and home health agencies enrolling in Medicare. CMS also announced that it will defer $1.3 billion in federal Medicaid funding to California. Meanwhile, the DOJ issued a release noting that an individual was convicted by a federal jury of a $1+ billion fraud scheme in Florida.

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