Good morning TWTW readers. With another soggy, news-filled week under our belts, TWTW is starting to think we’re ready for fall. Pumpkin spice lattes, anyone?

This week, in healthcare:

  • Making the cut: Amidst continued focus on PBMs’ role in drug pricing, Express Scripts announced this week that they will drop 48 branded drugs from their 2019 formulary. The changes are expected to save clients about $3.2 billion; according to Express Scripts, only 0.2% of members will have a change to their medication access next year.
  • Netflix and pill? As Louisiana’s “Netflix subscription model” for Hep C therapies garners additional coverage, the TWTW team is starting to wonder if states are becoming the new labs for innovation. Our on radar: the Blueprint provision that up to five states (unspecified) will be allowed to test drug coverage and financing reforms under Medicaid.
  • Healthcare gets holistic. In an op-ed for Fortune this week, Aetna’s president, Karen Lynch, examined the need for our healthcare system to pivot to wellness care. Lynch advocates for adapting our models to better treat the whole patient vs. their specific symptoms (e.g. treating people with cancer for depression and anxiety, which affect about 50% of cancer patients).   

But there’s even more news, so let’s get to it.


Earlier this week, HHS announced that Medicare Advantage plans would gain some negotiating power for drugs covered under Medicare Part B. With this change, set to go into effect in 2019, plans would be able to negotiate for discounts and rebates, and apply step edits to certain medicines. The plans could also manage a class of drugs across Parts D and B. The effort has been announced as a cost-saving initiative, with Secretary Azar saying: “By allowing Medicare Advantage plans to negotiate for physician-administered drugs like private-sector insurers already do, we can drive down prices for some of the most expensive drugs seniors use.”

While this change is planned for 2019, its longer term impact will be more obvious in 2020. It will impact certain categories, particularly diseases like rheumatoid arthritis or oncology where therapies are available at the pharmacy but can also be administered at a hospital or practice. Azar noted the cost-savings from the program will directly impact patients, with over half of the savings going back to patients. He also mentioned that patients could apply for an exception from step edits or switch plans if they were not satisfied with their coverage options. Still, the change may see some pushback from some advocates, who have firmly stated the importance of patient choice and the potential harm of step edits on patient experience and outcomes.


As you know, TWTW team is a bunch of new junkies. We’ve recently seen quite a bit of coverage focused systemic gender-based disparities in the healthcare system—and the harmful, often life-threatening impact on female patients. Specifically, recent stories have examined the rampant overlooking, underdiagnosing, misdiagnosing and undertreating of female patients. The causes?  Well, it’s due in part to how the health system measures pain, and has been reinforced by the clinical trial model, which for decades did not include women. According to studies, the disparities cut across all diseases. For example:

  • Women are more likely to receive stress tests when they experience chest pain, and less likely to be admitted to hospitals.
  • Diseases that affect predominantly more women, like Alzheimer’s, are understudied. 
  • Female cancer patients experience a longer lag time from early symptoms to diagnosis.

Moreover, the impact gets worse when gender is combined with other factors: socio-economic status, race and weight can further impact the kind of care women receive. A harrowing feature for the New York Times, examines the maternal mortality disparity for black women in America. The Atlantic’s piece on healthcare “gaslighting” offers the example that women with Polycystic Ovary Syndrome, a condition that can cause obesity or weight problems, are routinely advised to eat less and exercise more. Regardless of the condition or statistic, these stories all have something in common: they highlight how women’s unique health needs and risks have been woefully overlooked by the current system.

While recent research and storytelling has certainly evolved our understanding of this issue, scientists have been investigating it for some time now.  The chest pain data (above) was released in 2001. But as the #MeToo phenomenon evolves, it’s incorporating all sorts of stories about the ways in which women are routinely disenfranchised by established systems. Add that to our populist, politically polarizing, pre-midterm environment, and you’ve got a trend with serious potential to impact the healthcare industry.

So what do pharma and biotech companies need to consider?

  • Start with the data. Take a look at clinical trial design and ensure it accounts for biological differences, gender prevalence and other factors that could skew results if not controlled for.
  • Find some female docs.  When treaters better identify and understand their patients, outcomes improve. Nothing shows this more clearly than a new study, which found female heart attack patients were 2 – 3 times likelier to survive if they were treated by female doctors.
  • Have more women in the room, and give them the mic. In the opening remarks of the review of treatments for endometriosis, ICER’s Chief Scientific Officer Dan Ollendorf opened by acknowledging, “You’re only going to be hearing about endometriosis from a bunch of men, so I apologize for that.” (ICER, 2:05) Women are often missing from critical conversations, even those about conditions that only affect women.
  • Consider the moment. With Justice Kavanaugh’s hearing now set for September, reproductive health is one of the nation’s hottest topics. It’s also a topic that consistently ranks as one of the most polarizing issues for companies to associate with. Companies with women’s health treatments (especially contraception) must remain alert, ensure their communications are sensitive to the landscape and be prepared for activist behavior.  
  • Know your patients. Patients are more than just a condition, with their jobs, families, home situations and financial circumstances playing key roles in their ability to access and comply with treatment. Companies that go out of their way to reach and engage patients to learn about their unique needs will be more likely to gain the competitive edge and the appreciation of the community. 

For those TWTW readers wanting to delve deeper into this topic, we recommend the BBC’s series on the “Health Gap.”

That’s all from us. Have a wonderful week.
-  The Reputation & Risk Management Practice@ Syneos Health Communications

About the Author:

We are a team of healthcare communicators, policy-shapers and crisis response specialists. Drawing upon professional experiences from Congress, CMS, HHS, hospitals, and health technology—and our collective work in rare disease, oncology, diabetes, gene therapy, pain management and infectious disease—we provide unique solutions to the evolving messaging challenges in today’s healthcare industry. We support our clients with evidence-based approaches to preventing pricing pushback, protecting brands from modern activism, establishing and communicating clear policies surrounding expanded access to medicines, and a proactive approach to value frameworks. Our offerings also include product safety, litigation, regulatory risks, ex-U.S. considerations and policymaker investigations.