January is always a tricky month for the MM&M editorial staff. Many readers expect a nod to what’s to come. Others, not so much.
We’ve tried to strike a balance between outright prognostications and mining the sometimes complicated history of our industry for forward-looking insights. Fans of the former will find a number of them this month from industry experts, ranging from data leaks to the Affordable Care Act and the future of pre-existing conditions.
As for the backstories, allow me to start with our piece on GlaxoSmithKline’s return to paid speaking. In 2013, Andrew Witty, then-CEO of GSK, made the decision to cut back on paying physicians to give talks to other clinicians about its products.
But GSK’s peers never followed suit, and responses to the company’s October decision to lift the ban were laden with schadenfreude.
The company said curtailing the practice “led to reduced understanding of our products.”
The fact remains that speaker programs are a valuable marketing asset. That leads me to wonder where we may see a return to other tried-and-true marketing practices.
Payer-pharma collaboration is another area where a revival is taking place. Not since the two partnered back in the ’90s on disease management programs have we seen this level of cooperation. The ACA and focus on the triple aim rekindled interest. Today, value-based contracting has arisen as a way to keep that slightly open door more ajar — and perhaps to swing it open wider.
Finally, our take on accumulator adjustment programs exposes the sordid underbelly of pharma-payer dealings. Health plans employing these prevent patients from getting credit toward their out-of-pocket expenses when a co-pay card is used at the pharmacy.
Accumulator programs emerged in 2016 and are now used by all major plans and employers. And yes, they save plans money, but at what cost? By discouraging appropriate utilization of pricey specialty drugs, which are most at risk.
If patients with chronic conditions simply abandon their prescriptions, they could wind up in the hospital, costing plans even more. That means 2019 could see manifold stories of patients caught in the crossfire — a sobering thought. Let’s hope for a reconciliation.