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Bizarre that Ricks calls out @icer_review as funded by someone who hates pharma (implying me) and then responds to question about how to catalyze pharma R&D by calling for independent body to assess drug’s risks & benefits and recommend fair price, which exactly describes ICER.
Nov 11, 2025
Dave Ricks has been at @EliLillyandCo for 20% of its 150-year history. He came to the pub, poured his own Guinness, and gave us a 2-hour state of the pharma union: drug prices, clinical trials, patent clocks, the rise of generics, Chinese peptides, compounding pharmacies, the US healthcare system, and how the broad success of GLP-1s have transformed Lilly's business. If you've never heard Dave speak before, you're in for a treat.
Timestamps:
00:00 Intro
05:08 Making R&D decisions
10:11 Clinical trials
24:59 Drug pricing
32:43 Stimulating more R&D
45:16 Pros and cons of US healthcare
58:20 New pharma business models
01:05:53 Stripe + enterprises
01:07:00 China
01:16:31 Generics
01:22:37 GLP-1s
1:37:43 r/Peptides
01:41:25 LillyDirect
01:46:35 Why do investors love LLY?
Then he proposes a method for fair global pricing so Americans don’t get ripped off: int’l pricing would be the GDP/capita adjusted US price. If $100 in US then $70 in UK.
Collison: You could do that today.
Ricks: We could.
Collison: Why not just do it?
Ricks: (changes subject)
This keeps getting worse. Ricks then calls for a federal law that bans any purchaser from negotiating on price. He’s not just against gov’t negotiation. He doesn’t want any buyer to negotiate. Can a payor ever ask for a volume discount? Nope. Everyone is a price taker.
I am glad to see we agree on site neutral hospital payments. A blood draw shouldn't cost $600 just because it's done in the hospital. @Arnold_Ventures has been the leader in pushing for more rational hospital pricing.
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