"Alexa, who else is listening?” That’s what we’re wondering after reports that Amazon has thousands of employees listening to conversations captured in your home. Their job: to transcribe your commands and use them to improve Alexa’s comprehension.
With millions of people placing Alexa’s all over their homes and offices, the news raises red flags about privacy and what the speakers are picking up - beyond asking Alexa for the weather. Singing in the shower, fights with your boyfriend, intimate moments with family …Alexa might know more than your diary!
How is this legal you ask? According to Amazon, auditors aren’t provided with the users’ full name and address, but they are given an account number, first name and device serial number. Amazon does inform users that they “use your requests to Alexa to train our speech recognition and natural language understanding system,” and that can be disabled in privacy settings. But, they don’t explicitly say that humans are listening (and might even share recordings in an internal chat room).
Think you’re safe without Alexa? Apple and Google have similar processes for their virtual assistants. Big brother is watching! … and we hope he enjoys our healthcare headlines in The Week That Was.



Falsely Positive? – A study from genetic information company Invitae found that 23andMe misses almost 90 percent of carriers of a BRCA breast cancer mutation. 23andMe’s response: It makes clear to consumers that its DTC genetic test looks for three common variants in the BRCA1 and BRCA2 genes, out of thousands of potential variants. When the test was FDA approved last year, The American College of Obstetricians and Gynecologists (ACOG) warned that a negative test “may lead to false reassurance for an individual woman, and the potential that she will not obtain the appropriate evaluation and counseling to determine if she may be a candidate for additional testing using a more expanded panel or benefit from enhanced screening protocols.”  


Airwave Activists - While some companies are proactively getting ahead of the Trump administration’s proposal to disclose list prices in pharma ads, opponents of the rule are gaining new allies: broadcasters and advertisers. The Association of National Advertisers and the National Association of Broadcasters say the rule violates the First Amendment and singles out TV advertising vs. digital, print and radio, which are not included in the policy proposal. Pharma spends as much as $6B on TV ads each year, and the ad and broadcast industries are worried the proposed rule will impact their bottom lines.


Sitting Pretty – Thinking about skipping the gym today? Well, a new study supports your laziness. It found that sitting for more than 13 hours a day may counter any benefits you receive from exercise. Between our work-a-holic-ness and penchant for chilling with Netflix, we’re in trouble. Walking desk anyone?


 Sour Not Sweet – Insulin manufacturers and some pharmacy benefit managers (PBM) testified before the House’s Energy and Commerce Committee. While some companies have recently taken steps to address the price of insulin recently, it was not enough to appease the policymakers. Rep. Joseph Kennedy (D-MA) said, “It took 15 years and global public outcry to do it?” Reminder: responsibility campaigns following public scrutiny do not typically get the same response as compared to when they are initiated in neutral climates.


To the Moon, Alice – Spending a long time in space does not impact your biology. That’s according to a study of astronaut twins Mark and Scott Kelly. In the Twin Study, Mark stayed on Earth while Scott spent a year on the International Space Station. Scott experienced numerous physiological and chromosomal changes during his time in orbit, but most returned to normal after 6 months back on Earth.


Pulse on Pricing
with help from co-author Michelle Leeds 

Winter is coming… this spring. While we’re excited for the Game of Thrones season premiere this weekend, we’re talking about drug pricing legislation. We’ve seen many hearings on drug pricing in the past few weeks, and there’s been a few bills that have made it through committee. Now, according to the Washington Post, U.S. House of Representatives Speaker Nancy Pelosi is looking to bring a package of policies to a vote in the full House in May. There’s a strong possibility new laws to increase transparency and competition within the life sciences industry are on the horizon.

Here’s a quick rundown of some of the pricing proposals that could end up in a package:

  • The STAR Act (H.R. 2113) would require manufacturers to “justify” price increases at certain thresholds (i.e. 10% increase per year or 25% over three years). PBMs would also be required to publicly disclose rebates.
  • The Protecting Consumer Access to Generic Drugs Act (H.R. 1499) would ban pay-for-delay deals.
  • The CREATES Act (H.R. 965) makes it easier for biosimilar manufacturers to obtain original samples.
  • The Payment Commission Data Act (H.R. 1781) would make more drug pricing and rebate data available to MedPAC and MACPAC to hopefully better inform their recommendations to Congress.
  • The BLOCKING Act (H.R. 938) would allow the FDA to approve a generic drugmaker's application to bring a competing drug to market if the first generic manufacturer to apply has not launched its product. The bill is intended to discourage drugmakers from taking advantage of extended exclusivity periods.


Rebate Redux

Rebates continued to be in the news this week for several reasons. They were a hot topic at the Senate Finance Committee’s hearing on drug pricing with leaders from five PBMs. Also, comments were due to the Trump Administration’s rebate rule that would remove and replace certain safe harbors for rebates. And, the Medicaid and CHIP Payment and Access Commission (MACPAC) made a recommendation to Congress on the topic.

Our Take:

The Hearing
The Senators had a less antagonistic tone with the PBMs than they did with the pharma companies in prior hearings. The conversation focused on who benefits from rebates (are they passed through to insurers, employers, patients?) and spread pricing (in which a PBM charges an insurer more for a drug than the pharmacy paid it for the same drug).

Lawmakers hinted at potential policy requiring transparency in the negotiation process. The PBMs testified that public transparency would hinder their ability to negotiate with manufacturers, but would potentially support a confidential disclosure to government entities.

The Senators also hinted at potential policy around spread pricing, which the PBMs present seemed to support. What that looks like remains to be seen. Just days later, the heads of the Senate Finance Committee sent a letter to the Health and Human Services inspector general asking him to investigate spread pricing practices and if they are leading to “inappropriate profiteering and potential anti-competitive practices.”

The Rule

According to Politico, more than 25,000 comments were filed in response to the Trump Administration’s proposed rule that Medicare & Managed Medicaid should no longer enable rebating for drug formularies unless the rebate is directly passed to consumers at the point of sale. Pharma applauded the proposal, but asked for a few clarifications on how the discounts at the point of sale would work and additional reforms addressing PBM service fees. Payers largely disapprove, noting that it would upend the transition to value-based care and lead to premium increases. A second rule proposed would require PBMs could only take flat fee reimbursement from manufacturers instead of the prior model which used a percentage of the drug’s list price.


What is MACPAC? It’s a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to policymakers on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). They’re now getting into the rebate debate, recommending more flexibility for rebates in the Medicaid program. Currently, rebates are capped at 100% of a drug’s average list price. The group estimates that removing the limit could save the federal government $15B-$20B over 10 years. 

Who wrote this? The managing editors of TWTW are Randi Kahn, who is glad she never jumped on the virtual assistant bandwagon, and Dana Davis, who unplugged her Alexa a long time ago and hasn't looked back.

Syneos Health Communications' Reputation & Risk Management Practice is a team of healthcare communications consultants, policy-shapers and crisis response specialists. We provide unique solutions to the evolving communications challenges in today’s healthcare industry, using evidence-based approaches to help our clients successfully navigate the most sensitive of situations.

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Image credits: DNA by Lloyd Humphreys from the Noun Project, TV by H.A from the Noun Project, Chair by Liza Mulloy from the Noun Project, spaceship by Slogh Holding from the Noun Project, Pharmacy by lastspark from the Noun Project

And now please enjoy this disclaimer that prevents our team from getting in a heap of trouble: This report may contain links to external or third party websites. These links are provided solely for your convenience. Links taken to other sites are done so at your own risk and Syneos Health accepts no liability for any linked sites or their content. Syneos Health makes no warranties or representations, express or implied about such linked websites, the third parties they are owned and operated by, the information contained on them or the suitability or quality of any of their products or services. Syneos Health does not authorize the infringement of any intellectual property rights contained in material offered through these linked sites. Please refer to the use agreement and/or copyright statements of any external site you visit, or the terms and conditions of any externally provided web site for instructions, restrictions, and guidelines. If you have a question, please contact the webmaster of the external site.

About the Author:

Randi Kahn is a Senior Media & Content Director in our Reputation & Risk Management Practice, where she helps clients build and protect their brand reputations through executive thought leadership, public affairs, and issues preparation and response. She has worked for clients throughout the healthcare ecosystem including payers, providers, patient groups and pharma.