November 3, 2025
Welcome to Perspectives, a signature podcast series from The Leerink Center for Pharmacoeconomics. Hosted by Dr. Mel Whittington, a health economist and Head of the Center for Pharmacoeconomics, we will be hearing from individuals across the industry to better understand and appreciate the societal impact of healthcare innovations.
Diane Vieira: Hello and welcome to today’s episode. I’m Diane Vieira, Head of Marketing and Communications at Leerink Partners, and I’m excited to be joined by Mel Whittington, Head of the Leerink Center for Pharmacoeconomics. Over the past year, Mel has led the launch and growth of CPE, bringing in new insights to the intersection of healthcare investing and health economics. Today, we’re gonna reflect on one year of CPE, what surprised her, and what’s ahead in year two. Mel, first of all, congratulations. It’s been a full year since we officially launched CPE. How does it feel to be sitting here one year later?
Mel Whittington: Oh my gosh, I can’t believe it’s a year. And I want to say congratulations to you too. I’ve so enjoyed getting to be able to work with you so closely for the last year. And I’m really proud of what we’ve been able to achieve together. As I think back about a year, I remember when I first became a parent and everyone kept telling me that days are long, the years are quick. And that’s so true. My oldest just turned nine last week. So, I feel that the years are quick. And as I reflect on my kind of time at CPE, I honestly think it’s the opposite of that. In that the days are really quick, but the years are long. And I mean that in a good way, in that every day there is never enough time in the day. There are so many things to read, so many questions to answer, so much work that can be done, so many drugs to evaluate, so many people to talk to, that there’s never enough time in the day. But then when I think about, we’ve only been doing this for a year, that’s wild to me. Like I’ve met so many people, you and I have become such close collaborators. I’ve learned so much. I look at things in kind of my role as a pharmacoeconomist completely differently from when I did a year ago. And so, you know, when I look back at the last year and think about the content we’ve put out, I’m really proud of how much we’ve done, and I cannot believe it’s only been a year.
Diane Vieira: I echo that. It feels like it’s been 10 years, but yes, a lot of great work happening. I love that perspective. And hearing you say that you look at things differently, that’s powerful too. It shows just how transformative this past year has been, which is always what everybody looks for. So, speaking of transformation, you’ve made a huge shift this year, right? Joining a brand-new industry, that’s no small leap. So, what, if anything, really surprised you?
Mel Whittington: Yeah, a lot. If I could kind of summarize it, I’m probably surprised to see how similar, yet so very different kind of the healthcare investing side is that I now get to be a little bit of a fly in the wall for from my side that I’m used to, and that’s the health economic side. And how they’re similar, really opportunity costs are so core to both sectors. So, in my world of health economics, we think of opportunity costs all the time. We think about like, hey, we have pooled population dollars, maybe it’s our insurance premiums, and how can we use those efficiently? How can we maximize the use of that money to get the most health in return? And if we spend money on one thing, it may not be available to spend money on something else. And so, these kind of grappling with opportunity costs are really core to health economics. One of my biggest surprises from being a of a fly in the wall, in this healthcare investing financial services world is opportunity costs are so core to this world too. And it’s a little bit different instead of these kind of pooled population dollars, insurance premiums, it’s pooled investment assets. But the same philosophy holds. If you invest in this drug, then you may not have the resources available to invest in another drug or in another sector. And so similarly, these investors have to be thinking about maximizing the use of those resources. How can those resources be deployed to maximize the returns? There’s no one saying, “hey, this amount of money has to go into healthcare.” There has to be kind of these opportunity costs that are considered. So, I would say that how they’re similar, such a huge focus on opportunity costs in both sectors of the industry. How they’re different is how we talk about things. So, I’d say kind of on the financial services, healthcare investing side, mind you take this with a, you know, I’ve only been fly a on the wall for a year, but really when a drug is talked about or when a pipeline product is talked about, the business side is talked about. The incentives, the risk, the capital, that is core to a lot of the conversations, and it is a business and that should be talked about. On the flip side, on the health economic side, it’s not as much the business side that’s talked about. It’s the impacts, the costs, the consequences. How does this drug or this pipeline product impact patients, the health system, society? And so, the core things that are talked about in these conversations are different with the investment side talking about the business and the health economic side kind of talking about these outcomes.
Diane Vieira: If the two worlds could borrow from each other, right? So, there’s clearly an opportunity to do things differently. What do you think healthcare investing could learn from health economics?
Mel Whittington: I think healthcare investing can lead and kind of lean into the impacts of the products that they’re working on. And obviously I’ve already acknowledged I’m a modeler. I see the world through economic models, but I do think companies and company builders should lean into economic modeling as a way to extrapolate the impacts of their products and think about what does this do for patients, the health system, caregivers, and society. I would love to see a world where after a company has phase two data, thinking about how would this perform on a GCEA or a generalized cost effectiveness analysis framework that drugs do amazing things. So, I think companies and company builders can really evaluate this and communicate this to show why the expected market-based price should be seen as worth it and show all of the potentially miraculous things that these products can do for patients and society. And so I would love to see this world, if a product makes it to approval and is launched, when there’s people talking about the price, I would love for them to say, rather than it’s what the market would bear, say, why the market understood that the price is worth it and what this drug has the potential to do for stakeholders and for patients. And so, I think the companies and company builders really should lean into the impacts that their products have because these are influential products and they should celebrate that.
Diane Vieira: That’s such a key point, making the price make sense in terms of value, not just tolerance. Flipping that same question, if I pose to you what could health economics learn from healthcare investing, what would you say there?
Mel Whittington: Yeah, you know, I think healthcare economics needs to acknowledge that this is a business. Very similar to kind of what healthcare investors are frequently talking about, the business side of things. I think health economics could acknowledge that this is a business. It’s a business that requires a ton of private capital and risk. And so adequate incentives do have to exist for this kind of business to be able to run. And you know, this probably will come as a surprise to no one, but there is a market and there are market dynamics and so, you know, I believe strongly in trying to incorporate these expected price changes of a drug over its time in the market within our pharmacoeconomic models to just make them a little bit more realistic. And I think pharmacoeconomists, you know, can be involved in some methodological advancements to just better acknowledge that business side and the importance of adequate incentives because listen, health system efficiency is extremely important, but also preserving the incentives for more innovation is also important. And I could say the same thing for the healthcare investing side, that preserving the incentives is really important as is health system efficiency. I recently wrote a commentary with some folks at the National Pharmaceutical Council, John Campbell and John O’Brien, and then Lou Garrison, and it was really looking at kind of health technology investors and health technology assessors. And they’re both really, really important and they’re both focused on the efficient allocation of resources. And there could probably be ways that they could learn from each other and be a little bit more synergistic.
Diane Vieira: So, I think what I’m hearing you say is that both sides have blind spots, right? And the real value comes when they do try to learn from each other and kind of get that perspective. And that’s exactly the bridge you’ve been working to build at CPE and well before that.
Mel Whittington: I do, and both are really important and play different roles, but I do think we need a little bit more of thinking about the different players and how can we learn from each other, how can we improve, and I think we can always do better.
Diane Vieira: So now if we look back at CPE’s first year, which we’ve already identified feels like year 10, it’s been a busy one. We’ve put out a ton of reports, thought leadership. It’s really shaped the conversation. If you had to pick a project that you were most proud of, would you be able to? And if so, what would it be?
Mel Whittington: Yeah, I would. I think one that stands out pretty strongly to me is our generalized cost effectiveness analysis of Entresto. So, we released that GCEA earlier this year, earlier in 2025. And when we did release that, Entresto was still under its patent protection. It had market exclusivity. Generics were not in the market. But in that CPE exclusive, we said we expect downward pressures to the price to be coming due to generic entry after patent expiration. And we accounted for declines in the price over time. And observing how the market works to reduce drug prices over time is so core to my personal learning and development over the last year. And this consideration of how a drug’s price changes across its life cycle was not an emphasis of mine until relatively recently. And honestly, it was a big motivation for me as to why I wanted to join the folks at Leerink is to really observe this and study this and think about like, how does a drug’s price change over time? How does the market allow that to happen, support that to happen? And then how can we implement that in pharmacoeconomic models that I build to be more realistic, to be better, try to be as accurate as possible in the estimation of opportunity costs. And so, because dynamic pricing is so central to what I think health economic models could do to improve, the Entresto GCEA was a little bit of like a, okay market, prove to me you work. We’re gonna put this report out before generics enter. Let’s just see what happens. And you know, the market worked. Generics were hungry to enter. The price was dramatically reduced. Generics entered and some of the generics are priced more than 90% less than estimates of its net price before generic entry. And so, the Entresto GCEA kind of has been this ongoing case study that I keep going back to over the last year thinking about what incentives were there for generics enter, how did, let’s kind of observe in real time together, how generic entry is impacting the price and how that price is falling off a cliff over time.
Diane Vieira: Such a clear example of theory meeting practice and the market responding just as the models had predicted. So powerful. And I just want to switch gears now for a second. So, beyond CPE’s work, obviously the whole industry has been buzzing about US drug prices, sweeping policy proposals. You’ve had a front-row seat to that. So, what stands out to you from all of that?
Mel Whittington: Yeah, you know, maybe that’s one reason why the last year feels like it’s been 10 is there’s just been, there’s been a lot going on. And honestly, I’ve kind of tried to stay away from the immediate headlines and think more about kind of the underlying trends that have been happening over many years and not be as reactive or responsive to, you know, something that seems to be happening at this very moment. And I think the underlying piece that I keep going back to is this biopharmaceutical innovation ecosystem, it’s full of different players. You have the drug developers, you have the investors, you have the regulatory officials, the health technology assessment bodies and so when there’s all of these different players, I think it’s easier to kind of stay in our lane and think about like, what is our unique objective? What is our unique goal? But then that kind of ignores that, you know, we’re actually an overlapping system that is all really focused on kind of getting the right drug to the right patient at the right time. And so, I don’t think we are working across players or with each other all that well. And I think we have some room for improvement there. And we need to work as a system. We need to think beyond our unique objective and think about like, you how can I achieve my objectives and be part of this larger overall system? And to do that, I think we kind of need to understand the other players’ objectives and understand the goals. You know, last month we had a podcast with Dr. Steve Potts and he and I were talking about how, you know, I think everybody kind of wants three of the same things for healthcare. And then is reducing out-of-pocket cost to patients, using resources efficiently, and we do want more drugs. I don’t think anybody is fully content with the drugs that we have approved right now. We want more; we have health conditions that we need solutions for. And so, I honestly think the fact that we all probably care about the same thing is a really good thing. Our eyes are on the same prize. Now we need to work together across all these different players and figure out how we can get that and achieve our own goals in a manageable way. And the thing is, we have a lot of amazing healthcare innovation right now that’s already developed and in the pipeline. And we certainly want to continue to incentivize that. And then on the flip side, healthcare in general is also really expensive. I’m not only talking about branded prescription drugs, which is healthcare is expensive, life is expensive. And so there are going to be pricing pressures. And so, we all kind of to figure out what we can do to achieve those things.
Diane Vieira: Such an important insight. I mean, the idea that we often share the same goals but fail to act together. And yet, as you said, everyone ultimately wants the same things, right? Lower out of pocket costs, efficient resource use, and more drugs coming to market. It does feel like there’s common ground to build on. It’s just people needing to mobilize in the same direction. Which now brings me to you personally, right? So, over the past year, you’ve built in conversation or been in kind of these conversations and build bridges with investors, companies, analysts, anchors. How has all of that evolved your thinking?
Mel Whittington: Yeah, you know, I’m so like sincerely grateful that Leerink gave me this opportunity because in only a year of engaging with some other players in the industry, these are investors, clinical stage companies, equity research analysts, my like health economist perspective, the health economic hat I wear, it’s really changed. And my eyes have been open to all of these different players, and I can see how, okay, maybe some of the things that I would do would conflict with their objectives or goals and maybe some of the things that they would do could conflict with my objectives or goals. And I’m kind of referring to “my” as kind of the health economic perspective. And so, I’ve had like a variety of these aha moments over the last year. I think one of the biggest ones is, and I think many people would share this and that it’s really easy to see like the price of a branded drug and be like, that is a huge number. Surely that could be much lower, right? Like, I don’t think that’s unreasonable to think. But then through this experience, I have learned that it’s like those rare few commercial successes have to be so successful to make up for all of the bets that weren’t commercial successes to justify that risk and capital. And this has honestly changed how I think about a drug’s price and that we’re not just paying for that drug. We’re kind of dangling this big reward. So, investors and developers want to fight for that reward and invest their money in biotech. And so, us as a society can get more drugs. And so, the price of a drug is not just a price, but it’s also a kind of a prize or an incentive. And that incentive has to be high enough to justify the risk and the investment. And biotech is very risky and capital intensive. We’ve tried to have a few podcasts; one particular stands up that we did with Ulrich Neumann where he talked about how much money and how much risk goes into biopharma research and development. And so, the incentives have to balance that. We have to think about the incentives, and we have to make sure those are adequate to justify the risk and the capital. And maybe like one other kind of aha moment from the last year was, I used to think of like biopharmaceutical innovation or prescription drugs as like academics doing work at academic medical centers, doing research, and then also like big pharma. And now I realize there are literally thousands of small biotech companies with funding from private capital. And this kind of biopharma innovation really is a small business business. And that’s really changed how I think about the industry. You know, I don’t think of, you know, kind of a big pharmaceutical company name as the first thing I think about. But, you know, now I think of the faces and the names of the biotech CEOs I’ve been fortunate to meet over the last year, and the reality is biopharmaceutical research and development, it’s a huge and interconnected ecosystem, includes a bunch of different players and each have a really differentiated and important skill set. you know, I think the general population doesn’t really get to see that as much.
Diane Vieira: I’m a real-life converter. You helped me see and educate me on that process because like me, like many other humans in the world are just kind of like, “that price should be lower”. But what we don’t see is the pipeline and the process and the years of development and everything that went in to get that medicine to where it is, you know, improving human health. And so, I think that is the key that sometimes people who aren’t in it aren’t necessarily seeing. So, I kind of love how you describe that. It’s not just about gaining knowledge. It’s about developing empathy, right? Seeing the risks, the failures, the human side of the business. And it really reframes for us the whole ecosystem and how people think about it.
Mel Whittington: Yeah, I think that’s an easy thing that we can then look inward as an industry and be like, okay, how can we communicate that better? How can we talk about the risks? How can we talk about the private capital that goes into this? And I also think, you know, genericization is so important to the work that I do and thinking about advancements in pharmacoeconomics, we also don’t talk about like generics entering the market and like guess what? Prices just dropped dramatically. And so, I think all of these little lessons are things like we can all do better and take a little chunk of that moving forward.
Diane Vieira: Agree. We’ve accomplished obviously so much so far this year, but still so much to do. So, you know, what should people expect from CPE in year two and beyond?
Mel Whittington: Yeah, I think over the last year, we’ve thrown out a lot of different types of content, a lot of different flavors of content. And I sincerely appreciate those who stuck around as we kind of refined what is our unique contribution, what is CPE. And so, I think in year two, I think we’re going to lean into things that make us unique. And that is being this bridge between the healthcare investing world and the health economics world. And so, I want to bring a little bit of health economics into the development stage and evaluate and communicate the impacts and the health system and societal efficiencies of certain healthcare technologies. And so, we’re going to do this through our CPE exclusives. We’ve released a few historically, but this is really where we do kind of a GCEA of healthcare technologies. And so those will continue and will be our way to kind of bring health economics into kind of this healthcare investing development side. It’s just interesting content and information. I also really wanna be kind of bring the healthcare investing development side of things out and kind of explain how the market works and what does the life cycle of a drug look like. Talk about some of the things that aren’t really talked about in the mainstream. And that’s kind of our intent of our newsletter. We have a newsletter called Diary of a Health Economist and this is really kind of an informal commentary around market dynamics and the life cycle of drugs. And so, I think those are our two larger pieces of content. One, the exclusives to kind of bring health economics in, and then the newsletter to bring kind of healthcare investing and market dynamics, et cetera, out.
Diane Vieira: Love it. I think what excites me the most about hearing that is you’re not just analyzing this hypothetical bridge, right? You’re literally building it between investing in health and economics and kind of merging those two things together, which is an exciting time. So, when you think about themes, opportunities to tackle for next year, what’s kind of at the top of your list?
Mel Whittington: Yeah, I think there’s two things. One is efficiency. And kind of core to that is value is often kind of thrown around with that. And one other thing I’ve learned since I’ve joined is when I say value, really mean like health system is societal efficiency. And then I can now understand that value can also be like a valuation of a company or value to investors. So that’s been a lesson learned for me. But I think, theme one is this this idea of efficiency and economic and societal efficiency and thinking about and communicating these kind of economic and societal impacts of treatments or potential treatments. So that’s theme one and I think theme two is really market dynamics, thinking about generic entry biosimilar entry branded competition the life cycle of a drug. I think those are kind of our two main themes that will probably drive most of our work in year two.
Diane Vieira: Yeah, well, big and important ones for sure. And I know listeners will be eager to kind of follow along as you explore them. But before I let you go, you know I always love to wrap up with a reflection question. If you had to sum up year one of CPE in a single word or phrase, what would it be and why?
Mel Whittington: I’m gonna choose a phrase and it’s going to be, “show me”. And so, I do live in Missouri, it’s the “show me” state and like what that’s supposed to kind of reflect is that the spirit of skepticism and a demand for evidence. And that’s kind of how I felt like with CPE. It was a little bit of like, show me that there is in fact a market, show me that drug prices are high for a period of time and then the market is designed for them to drop over time. And so, a lot of the work that I’ve been doing is really to show me, show me this is reflective of reality. So that’s my phrase, “show me.”
Diane Vieira: Love it. I mean, what a powerful way to close. I mean, show me evidence, proof, results. I mean, it kind of says it all. But Mel, thank you for joining me and thank you for all the work you’ve done to bring clarity and this bridge building to the very, very complex ecosystem of healthcare.
Mel Whittington: I could not have done it without you. We should probably get back to work.
Diane Vieira: Exactly.
Mel Whittington: Thank you, Diane.
Diane Vieira: Thanks.
Thank you for listening to this episode of Perspectives. If you’re interested in participating in future podcasts or would like to learn more about the Leerink Center for Pharmacoeconomics, please email cpe@medacorp.com.
