Economist Wayne Winegarden joins the podcast to expose how the 340B Drug Discount Program evolved from a small safety net for rural clinics into a \$100 billion revenue engine for massive hospital systems. He explores how misaligned incentives drive up drug spending, fuel hospital consolidation, and why transparency is the first step toward reform.

Treatment-resistant depression (TRD) affects millions of Americans and carries significant personal, clinical, and economic consequences. In this episode of the Health Policy Podcast, host Bryan Hyde speaks with Dr. William Sauvé, Chief Medical Officer of Osmind, and Mark Desmarais, Principal at Health Management Associates, about new research examining the impact of TRD on patients and the healthcare system.

Drawing on a comprehensive analysis of Medicare claims data, Desmarais explains how patients with TRD generate approximately $8,000 more in annual healthcare costs than patients whose depression is effectively managed. The discussion explores the reasons behind these costs, including higher rates of physician visits and hospitalizations, as well as their impact on both individuals and caregivers.

Dr. Sauvé, a psychiatrist with extensive experience treating complex depression cases in both military and civilian settings, discusses TRD, the challenges patients face after multiple unsuccessful medication trials, and the importance of identifying effective treatments. The conversation also examines workforce shortages in mental health care, barriers posed by prior authorization requirements, and how delaying effective treatment can worsen patient outcomes and increase healthcare spending.

Drug policy analyst Layal Bou Harfouch discusses the unintended consequences of New Mexico's SB 42, which allows the state to mandate treatment or remove newborns based on substance exposure. She explores how centralized, one-size-fits-all mandates bypass clinical assessments and create dangerous disincentives for mothers seeking prenatal care.