 So, before Tony comes back up to make some closing remarks, I just want to do some quick thank yous and a little bit of remaining housekeeping. First of all, thanks to all our speakers and moderators. We're very grateful to have you and your leadership in this work. Thanks to our vendors, Ridgewell's catering for the great food and to Spark Street Digital and for all the work you guys are doing to make this last beyond today and to everyone who's supported our event. I want to thank my staff at the Institute for Health Policy and across Kaiser Permanente who helped make this happen and to the Center for Total Health for your gracious hosting again for one of our forums. And most of all, thank you to everyone who came to participate today and help us move this work forward. As I mentioned this morning, we want to keep this conversation going. Some of that will take place, although the sessions will be available up on our website fairly shortly and the live streams will actually be available if you want to rewatch with tape delay. We'd also be grateful if you could participate in the short survey that we will send out not at the end of the day, but in about 22 minutes. So if you want to fill it out before you even leave the room, that would be great. But that will help guide us for future conversations in this space. And now I'm going to pass it over to Tony Beretta to share some thoughts on the day and thank you, sir. I'll knock you over in your way. So it's always a little awkward because you guys are ready to go and Murray just closed the session and now I get to say some stuff. I just want to add my thanks to everybody who did so much work on this and thank everybody for really spending the whole day here with some pretty deep content and interesting dialogue and for a change, a cross-section of views, I think, on this subject for us. So I think it was super helpful in a lot of ways. And I don't want to repeat what everybody said, but a few things that I took away from today is, and I think one message that was a theme through everybody's talk is that value is important, but it's not a be all and end all, that it's a facet of looking at how drug costs, drug pricing, the value of drugs, how they should fit into the health care system overall work. I thought I was surprised a little bit that there was as much leaning on and positivity about the concept of transparency still being critical. In the policy circles that we walk in, we've been working on drug pricing transparency for about four years now. And I have to say that in the state legislatures and to a lesser extent in Congress, there's a little bit of skepticism about how valuable transparency is. I still personally believe that it can serve important goals in keeping people focused on what's really going on. And I think some of the presentations that we heard today demonstrate that there is, I'm trying to figure out the right diplomatic way to say this. There's still plenty of desire to hide a lot of balls in the process. And having that transparency allows people doing these types of meetings, the people who are responsible for doing the policymaking, to actually keep focused on what is really the problem. And what we did see is a continuous return to the notion that the price is where this thing starts. We can talk about all the downstream effects and maybe how this got built up over years, but at the end of the day it's the manufacturers who elect to set the price where they set it. For whatever reason, they actually do that. So it was interesting to hear transparency. There are significant data problems if you want to move to a value-based system. That was a consistent message that we heard. A piece of that is the increasingly early approvals. I thought Peter Box slide showing the impact in his really quite elegant way of showing where's the value for the manufacturers in terms of the potential profitability and revenue is important to see. And there's a real need to improve the clinical evidence for these products that are coming to market very early. I didn't get to hear Jennifer's presentation, unfortunately, but I've heard her talk about these issues internally many times. And I hear constantly what I believe she said, which is the lack of evidence that exists for many of these extremely expensive drugs is creating virtual clinical crisis for our practitioners, for the pharmacists, for the physicians who are doing the prescribing and formulary management, and for the patients. Because we just don't know what's right for the patients when these products are coming to market so early. The notion of having to experiment on our own patients is a really disturbing reality and I'm sure it's not just within Kaiser Permanente. I think it's in other places as well. So having continued a dialogue about what kind of data really should be collected in the post-marketing surveillance period, what should happen with it, what who can do what with it is a crucial continuing conversation. I thought that Chris Liebman's comment for me it was the most just critical takeaway that I heard when he was describing how given the looser judgment of FDA over the quality of the submissions and the data that's provided that a really robust and well-produced application with strong data behind it can be given an A and a really loose application with not much data at all can also be given an A. And you know this would happen that other people in the organization would start raising questions about whether we really need to be putting all of that effort into dotting all the I's crossing all the T's and doing a great job on this stuff. That is exactly how reality works. When government regulation creates a hole or creates an incentive, people will logically ask themselves what do I need to do? It's the flip side of what we've seen with the Medicare Starrs program. The Medicare Starrs program came in in 2000, I guess it came in in 2012. We saw within our organization focus like a laser beam on these things that we were going to be judged on the amount of resource and effort that went into this was extraordinary and you can see it really drives people to execute. You lift that stuff, things will slide back the other way and this is sort of the same example of what's what's going on with the FDA. I thought that was incredibly helpful and a very very thoughtful point. I'd be remiss if I didn't reflect on the Steve and Matt conversation. Kudos to both of them for their diplomacy. You can see that both industries are extraordinarily well represented here in Washington. And I would say that it's pretty clear that both industries are still talking past each other in some respects. There's a rebate conversation going this way, there's a price conversation going that way. And I have my own personal position on that, so I won't get involved in who's right. But I will say that people are sticking to their guns and even as we have this dialogue around value, it's still coming from very different perspectives and different goals. And I think until there's a conversation that drills down below that, in some respects to the extent I thought Sean was getting at some of this was the need to have a different dialogue, I did enjoy the concept that we could have a different conversation about what the price should be and start at one point or the other. My experience in buying drugs from manufacturers has demonstrated that you don't really have that choice. You're starting with the price that they're actually starting with and you need to negotiate it down from there. But that was interesting because I think conceptually it's a strong point to say that value should be the ceiling and not the floor. I was surprised that Sarah didn't jump out of her chair on the evaluation of the Hep C drugs because I've made that criticism to you before and you jumped at me saying no, no, no, that's not how we actually looked at it. But it's interesting that that one where we all concede these drugs are really important and really good, there's still a number of us who feel that they're radically overpriced. And we're radically overpriced from the very beginning and then the measures are all over the place. So it start in 2013, 14, we started having this dialogue and it's been super interesting. I thought Barry's slide on the trajectory of the disease modifying therapies was stunning. And I thought her perspectives, I thought the story about Diane was very critical and moving. The reflection that I had on that particular point is thinking back to 20 years ago, historically Kaiser Permanente, it was almost a regular thing. I mean, we would have these conversations and our drug benefits were out of line with where the market was going. We had very comprehensive coverage. Our medical groups would argue for very low co-pays. We didn't really need to use the cost sharing tool to make sure there was appropriate utilization. But ultimately as the market just started drifting to higher and higher cost sharing, the cost of our benefits were getting out of line with the rest of the market. And ultimately we had to start following with these types of deductible plans that, you know, we have a pretty significant proportion of our enrollment. Now, do face these deductibles because those are the plans that the employers are buying for because, and they've been doing that because they've been trying to mitigate the cost increases that you've seen from the slide of those prices going up astronomically. So this thing is a vicious circle that's going on and we do need to try to get our hands on it and it does start with the price in the final analysis because most people are not ecstatic about offering the types of deductible plans that are out there. But it is how the balance is right now and how the balance of equities exists between the people who are paying the premiums versus the people who are enrolled. And so that's something that's going to continue to be a problem. The simple solutions to just stop having any cost sharing though doesn't answer the problem because then you have the economic problem of what are you going to do with the premiums and what are you going to do with the costs and are you simply doing this to lift any pressure on the pricing which is, you know, frankly part of the strategy. So we need to have a more real conversation about that and eventually get past the talking past each other. Again, I thought Lee, I thought Lee is probably over there somewhere. Lee, I thought, has always did a great job representing the really thoughtful perspective around value from a consumer perspective. Again, Barry, I thought did a lovely job bringing that patient perspective and that advocacy perspective. I am always so impressed that there's so much good thought going in here. Lee's really values in the eye of the beholder is the point that I think she's making and I think we all reflect on that. There's so much great thinking that's going on and this is a set of intractable problems and there's policy going on right now. And if we don't figure it out, there's going to be some radical solutions that are going to be pretty displacing for either the industry or consumers or someone else. But the solutions are not in place and the trajectory, notwithstanding some of the facts that are bandied about, the trajectory of costs is still high and moving in a bad direction and what we're facing in terms of the pipeline that's coming through is going to exacerbate the problem enormously. So we're having this conversation, a snapshot in time, but we know there's a massive pipeline in front of us that the economics of how competition is going to work in that space or not and what the expectations of the investors are, how competition can potentially work, it's not a pretty picture. And so we're going to be facing a lot of other challenges. I mean, thank you as well for a great presentation, really nice background. I will take you out for beers and we will have our annual fight over Medicaid best price and whether that really is a thing or not. Just you can come, Sarah, if you want, that's also fine. But I mean, there's so much good stuff to say. I guess, oh, the last thing, of course, I need to say, because Peter's already gone. I also appreciated Chris's, Chris said it, so I didn't have to say it first on like, should we throw in the towel on biosimilars? You know, it is an interesting thing that, you know, I'm sure if you get price controls on biologics, I guess fine. And you don't need, you know, if we had that on brand name drugs, I mean, I might not need generics, but, you know, I'm not sure that that's going to happen. But what we have seen is in Europe, it took time, as Chris pointed out, but there's a robust market for biosimilars and price concession. You know, pricing has come down 60 and 70 percent on a lot of things. We are seeing within Kaiser Permanente because of the great work of our pharmacists and physicians that we can get that type of incredible traction on utilization of those products and the pricing is starting to move. It's not there, but it's starting, you can see how it will start moving in that direction once we have a more robust supply and that starts operating more as a market. It's not that dissimilar to the old blockbuster era when you would have the first brand name in a class and then you get the second brand name in a class and there is competition at that level if you can manage utilization between them and drive bargaining. And that's how we Kaiser Permanente used to do really well during that era. I think the same thing is possible for biosimilars. The critical thing is you've got to make sure that that is coming and will work so that the people who are managing the care and managing the coverage have the incentives to invest in the infrastructure that's necessary to get the utilization. So that you get the utilization in control so that you can actually drive negotiations at that level. So I do think there's a lot of promise there. I hate disagreeing with Peter because he's so compelling about everything that he says. But, you know, I totally get where he's going with that. And then last, I think, you know, the question that continuously got raised on value and a couple of people raised this both in questions and from the podium, you know, what facet of value are we supposed to be measuring? Are we talking about individual value, value to the individual? Are we talking about the organizational value, the value to the, you know, fund holding, risk holding, health entity that is responsible for both medical and pharmaceutical costs? Are we talking about societal value? And, you know, I think on the societal value one, we get a little bit mixed up because we wind up in this dialogue over, it winds up being a dialogue over well. Steve Miller from Express Scripts always tells, you know, his methodology of pricing under this model is, you know, the pothole model. We don't pay for the front end, I said earlier, you don't pay for the front end alignments, you know, as the measure of what it should cost you to fill the pothole. And that is sort of the extreme example that Len was raising as well. And I do think that that is the question. It's like, where does the value actually reside? And I think from a societal value standpoint, equally important, and I think I referred to this in my opening remarks a little bit, is how can we get to an optimal place where the incentives are as strong as they can be for the best new innovation and the least reliance by the industry on the things that are already on the market? We want to have a fast cycle of innovation. We want to make sure that they're amply rewarded and then they're counting on the next thing coming along, not the stuff that's been on the market for 25 years. And too many of these products where the prices have gone up like this, they've had market exclusivity well beyond, you know, whatever anybody could have ever anticipated, and that's what we're dealing with. So the value question does provide insight into that and it helps us understand where the problems are and keeps us focused. So I do think that the session today was useful for helping us stay focused on where the real issues are. So you guys always give me that hard job of like summarize what everybody said in like 10 minutes. So that's as good as I can do for today. But again, let me reiterate, thank you all so much for spending so much time with us today, you know, we will continue to have this dialogue. We appreciate the opportunity to learn from all of you as well. And hopefully we will be back here again on this and other subjects in less time than you might expect. So thank you so much.