It’s no secret the pharma industry suffers from, let’s just say, a less-than-stellar corporate reputation. Recent reports suggest the debate over transparency and pricing is taking a big toll, of late, on the industry’s image. DTC may hold one of the keys to a reversal, if (and that’s a big if) industry can get its advertising strategy right.

Stay with me here. Last week saw the deadline for pharmaceutical companies to comply with PhRMA’s voluntary DTC Guiding Principles on drug pricing disclosure. PhRMA members decided last fall to make pricing information available to consumers by clicking through to a website whose URL is noted in their TV ads.

Readers will recall that PhRMA announced those guidelines in October, shortly before a speech by Health and Human Services Secretary Alex Azar, during which Azar was set to discuss a Trump administration plan to require drug makers to insert drug sticker prices right in their TV ads. Not surprisingly, Azar wasn’t impressed and issued a statement shortly thereafter in which he pledged to “go further” than the PhRMA guidelines. ”We will not wait for an industry, with so many conflicting and perverse incentives, to reform itself,” he said in a speech introducing the proposal.

The HHS final rule on drug pricing disclosure is expected soon, and is sure to be scrutinized from a legal standpoint. Moreover, PhRMA and others argue, the measure could confuse and mislead patients, since list prices in DTC ads wouldn’t reflect the true cost for most beneficiaries.

Nevertheless, Eli Lilly was first to begin running ads that direct patients to a website or 1-800 number for more detailed price information, for its diabetes drug Trulicity. Johnson and Johnson took the added step of becoming the first manufacturer to note the sticker price in a TV commercial, as well as making the information available by clicking through to a website.

And an early look at drug makers’ digital approaches shows they diverge quite a bit. For firms like Pfizer and Amgen (and Allergan and Lilly), pricing information for multiple brands is now corralled on a separate portal, while Bristol-Myers Squibb, Sanofi and AstraZeneca note list prices within individual brand.com sites, according to an analysis compiled by Bloomberg. In many cases, the dollar amounts are accompanied by explanation that what patients can expect to pay depends on what type of insurance they have, an estimate or range of potential out-of-pocket costs and available patient assistance.

A few days after the PhRMA deadline passed, research firm PatientView released results from an annual survey showing that, based on the views of 1,500 patient groups worldwide, in 2018 only 9% of the respondent patient groups said pharma as a whole was “Excellent” or “Good” at having fair pricing policies. That’s down from a high of 15% in 2015 and the lowest rating since 2011. Moreover, according to a recap of the report by STAT’s Ed Silverman, only 12% believe drug makers did an excellent or good job of disclosing or explaining their pricing policies, down from 13%.

Even more troubling, another well-known study of consumer sentiment, the Edelman Trust Barometer: Healthcare, this week revealed “the largest global gap ever measured” in trust in healthcare between the informed public (read: those who are college educated) and the mass population. The study involved more than 33,000 respondents across 27 markets.

“This inequality of trust underscores the instability of trust,” wrote Susan Isenberg, Edelman’s global health chair, in a blog post on Monday. “It also may be reflective of the mass population continuing to feel left behind as compared to others, even as they recognize the advances that are being made that could benefit them.”

As you might imagine, these researchers also found concerns about pricing to be closely related to corporate reputation. While addressing cost is a shared duty across the industry, Edelman observed, pharma takes the brunt of the blame. 13 markets out of 27 placed responsibility squarely on the shoulders of drug makers for the high cost of healthcare. Next in line were hospitals (5), followed by government insurers (4), commercial insurers (2), doctors (1) and “middlemen” (1).

Being transparent about the cost of their products and services was noted as one of three top actions companies can take to keep and earn trust, per Edelman. But big dose of skepticism here: No one ultimately knows if including pricing info will be perceived as transparent.

Yet something tells me that the industry’s hodgepodge of approaches to pricing disclosure is probably not the smartest way to reverse these trends and get patient approval and trust ratings going in a positive direction.

What do you think? Are companies merely adding to consumers’ confusion? Is digital disclosure, instead of TV ad transparency, yet another hurdle to patients seeing the actual cost of treatment? And can industry seize the opportunity of price transparency to earn back the public’s trust?