As we prepare to turn the proverbial page on 2018, we reflected on how this newsletter should close one of the most dynamic (and sometimes fraught) years in recent healthcare history. After much deliberation, we netted out with a healthcare yearbook. A yearbook has one foot in the past, even as it raises one hopeful step toward the future. It memorializes accomplishments and catalogs the hopes of where we’ll go.
In this edition of The Year That Was, we capture the trends that shaped the industry in 2018 and our predictions for the New Year. Oh, and check out our superlative “Most Likely To…” nominees. You’ll need to read to see who made the short list!
Read on for more details, superlatives and winter break reading lists…
►HEAD OF THE CLASS: TAKING ON HEALTHCARE BIAS
2018—the “Year of the Woman”—brought gender issues, including those in healthcare, to the forefront. Headlines frequently focused on the Health Gap: the fact that women are less likely than men to be taken seriously when it comes to their health needs. Stories and studies reported the medical establishment’s historical dismissal of women’s health conditions and descriptions of pain. Stories noting the persistent phenomena of “medical gaslighting” included how women’s heart problems often are attributed to panic attacks, endometriosis symptoms ascribed to infections, and pain blamed on hysteria (a word whose etymology involves the phrase “suffering in the uterus”).
It’s not a surprise, therefore, that healthcare was the top issue among women voters this year. Along with voting patterns catalyzed by healthcare, women are enrolling in med school in greater numbers than ever, helping to shape a female future for healthcare—with meaningful results. Women are more likely to survive a heart attack when treated by a female physician, likely owing to recognition of symptoms that are common in women. These results are echoed in other studies showing improved health outcomes among all patients (male or female) treated by female doctors, suggesting that female communication and listening habits may also play a role.
Heading into 2019, we already see some movement toward inclusion. Recently released research shows more scientists are using female cells and female animals in preclinical studies. However, this progress isn’t reflected throughout the drug development pipeline: pregnant women are often excluded from clinical trials, and NGOs and governments use the absence of trial data related to pregnant women to recommend against their inoculation, including vaccinating against Ebola. But a number of bioethics experts are calling for a change, and the FDA has indicated some agreement in draft guidance addressing pregnancy-specific research. In another attempt to fill in knowledge gaps, Congress has just passed a bill to tackle the maternal mortality crisis in the United States by funding state-level committees that will investigate all maternal deaths to understand the causes and devise solutions. As the midterm elections welcomed the most racially diverse, most female Congressional freshman class ever, we anticipate the incoming class to shine even more light on issues that affect subsets of women, including a focus on pregnancy and on racial disparities in healthcare.
This year-end focus on maternal mortality is especially relevant to intersectionality, as black women are three to four times as likely to die from pregnancy-related causes as white women. Black women are also twice as likely to be diagnosed with uterine cancer and more likely to die from the disease, and physicians routinely undertreat their pain. For African Americans, as for pregnant women of all races and ethnicities, their inclusion in clinical trials falls short, particularly in trials for the revolutionary cancer drugs that have come to market in recent years. Even when a disease is far more prevalent in black patients—like multiple myeloma—black patients are underrepresented in clinical drug trials for these diseases. As more of these health disparities come to light, we hope—and expect—greater efforts for inclusion by the healthcare community.
YOUR 2018 READING LIST:
Since releasing the Blueprint to Lower Drug Prices in May, the Trump Administration has been full steam ahead on its agenda to lower drug costs and reduce patient out-of-pocket expenses. Often taking a back seat to Commissioner Gottlieb and the FDA’s many, many proposals and guidances this year, the Centers for Medicare and Medicaid (CMS) released its own proposal last month to allow for more negotiation for drug discounts in the six “protected” class categories in Medicare Part D: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. Currently, health plans are required to include all drugs in these protected classes on formulary; for all other therapeutic categories, plans are only required to cover a minimum of two drugs. CMS said that its proposed rule would allow Part D plans to exclude drugs from formularies in the "protected" classes if their price increase is greater than inflation, or if CMS determines a new drug formulation isn’t a “significant innovation over the original product.” It also would allow “broader use” of step therapy and prior authorization—policies currently not in place for the protected classes. In a conference call with reporters, CMS Administrator Seema Verma said the proposed “flexibilities could save the government $1.85 billion and save Medicare enrollees $692 million in cost sharing over the next decade.”
Backlash was fast and furious. Groups from Mental Health America to the Medicare Rights Center and the American Cancer Society questioned the savings—nothing that the proposal could ultimately shift more costs more to patients as a result of access barriers. It’s not the first time advocates rallied around these classes—thwarting the Obama Administration’s attempts to reduce protections in 2014. Expect more agitation from advocacy and stakeholder groups through January when the comment period closes. However, of the proposals coming from CMS this year (DTC price disclosures and international reference pricing), we predict that this one gets the most traction on the Hill next year as the divided Congress finds common ground on drug pricing initiatives.
Drugs in these classes have two tremendous assets to help preserve patient access: highly engaged stakeholder groups and health economics. Research shows that moving stable patients off successful treatments—particularly for mental health conditions—will likely cost the system in more ER and office visits and additional pressures on social programs and services. Manufacturers with medicines in these categories should call on their HEOR teams to help weave these data into value narratives for meetings with advocates and partners, KOLs and on the Hill. When battling bureaucratic budgeting proposals, the best arguments have hard numbers behind them.
YOUR 2018 READING LIST:
Facebook most definitely didn’t make Honor Roll this year. CEO Mark Zuckerberg got called to the principal’s office aka Congress when he had to testify about Facebook’s role in the 2016 election, and their ties to Cambridge Analytica.
Unfortunately for Zuck, that was just the beginning of a downward spiral. In November, the New York Times revealed that Facebook knew about many of these issues earlier than they let on and how to handle it created a great deal of discord among FB leadership. Then in December, another report found that Facebook had been sharing more user data with certain advertiser-partners. And a new story is still developing about a Photo API bug that accidentally exposed millions of users’ unposted photos. Whoops.
Truth be told, it’s pretty tough to sum up The Year That Was for Facebook. But perhaps a quick look at where they are now might help:
►MOST LIKELY TO GET UNFRIENDEDFacebook is perhaps the year’s most topical, cautionary tale for corporate America—showing that there is such a thing as too many apologies. At a certain point, a lack of action and meaningful change discredits any creative messaging that seeks to achieve transparency, particularly when it comes to issues around privacy and data collection. While data-collection is becoming the new norm – and a critical necessity for surviving in a transparent market – the practice puts companies at a huge risk for consumer concerns and even activist targeting.
In 2019 we can expect this trend to come closer to home, especially for healthcare companies with privacy and security protocols that leave something to be desired. Also at risk are companies collecting sensitive health information. Given the already sub-par trust ranking of our industry, healthcare companies must avoid a transparency “scandal.” Our advice? Over-communicate with all your users as to what your policies are and translate into terms that the average person can understand.
YOUR 2018 READING LIST:
►COMMENCEMENT ADDRESS: STAKEHOLDER TRANSPARENCY REIGNS
Make no mistake, scrutiny of the relationship between third-party influencers and pharmacos intensified in 2018. In the news, we heard calls and saw tangible action for greater transparency and more comprehensive disclosure policies. Notable highlights include:
YOUR 2018 READING LIST:
►WILLS & PROPHECIES: 2018 RHETORIC TURNS INTO 2019 ACTION
Despite heated rhetoric for the last three years, legislative and administrative changes impacting drug prices have been modest. Policymakers are promising that next year will be different, and we’re tracking how changes may affect every part of the life sciences industry:
Oh, and some version of Medicare for all could pass the House next year.
►MOST UNDERRATED CHANGE IN WASHINGTON
YOUR 2018 READING LIST:
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Who Are We, Anyway?
Syneos Health Communications' Reputation & Risk Management Practiceis a team of healthcare communications consultants, policy-shapers and crisis response specialists. Drawing on our professional experiences from Congress, CMS, HHS, hospitals, health technology and biopharmaceuticals—we provide unique solutions to the evolving communications challenges in today’s healthcare industry. We support trade associations, biopharmaceutical and consumer goods companies’ in evidence-based approaches to successfully navigate the most sensitive of situations facing their industries. In our spare time, we drink too much coffee, geek out on healthcare news, and obsess over Sunday morning political TV.