So question is, are there therapies where the evidence may have changed over the years? Curious as you all take a look at this, how frequently do you look at the evidence? And as you're monitoring, you know, more time in market, more evidence, which therapy classes now have the strongest evidence and maybe where are we not seeing the evidence prove itself out?

I would say this is an area where we're still waiting for more data generally.

There are some specific examples of where we've seen some great information.

And this also goes back, if you don't mind, a quick tangent into the different ways that things come to market through the FDA.

A lot of gene therapies have been approved through what we'll just call traditional approval.

They've conducted clinical trials showing an impact on an important clinical endpoint, and then they get the approval.

We also have some gene therapies that have been approved through accelerated approval.

So as an employer is building out an outcomes-based contract, how do they know which timeframe to specify to really understand durability?

impact.So even at the cost that they are now, you would say that they're cost effective

It's really interesting.

We did a review of Wegovy semaglutide back in 2022, and the data that we had there, they looked like they weren't quite cost effective at the net price at the time.

Because of competition from Zepbound, which is one of the other major GLP-1s, as well as additional aggressive negotiation from payers and the government, the prices have come down, and we have new evidence of even more benefits.

Those are the two directions things can go to make something look more cost effective.

Sarah Emond from the Institute of Clinical and Economic Review says the gap has persisted for decades, driven largely by America's fragmented healthcare system.

There are agents in the system, like pharmacy benefit managers and health plans, who negotiate prices with the manufacturers and sometimes get discounts off of the price that was picked.

But how big a discount you get depends on a lot of things, the type of drug, whether or not there's any therapeutic alternative, what type of, um, condition it's treating.