The language experts from maslansky + partners take on the smartest, savviest, and sometimes stupidest messages in the market today. CEO Michael Maslansky and President Lee Carter bring their experience with words, communication, and behavioral science to the table—along with a colleague or client—and offer up a “lay of the language.” Their insight helps make sense of business, life, and culture, and proves over and over again that It’s Not What You Say, It’s What They Hear™.

In this episode, CEO Michael Maslansky, and Partners Lee Carter and Katie Cronen delve into the pharmaceutical industry’s enduring reputation struggles, tracing their origins back to pre-pandemic times and exploring the transformative impact of COVID-19. Through insightful discussions and case studies, they’ll propose strategies for reshaping the industry’s narrative, emphasizing the importance of recasting pharma as more than profit-driven entities and fostering consumer trust. 

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LINKS MENTIONED IN THE SHOW

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Lee Carter’s book, Persuasion

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TRANSCRIPT BELOW

HearSay Ep406 – Pharma Pricing

Michael Maslansky:

They said, what? Welcome to HearSay, a podcast from the language strategists at Maslansky and Partners, where we give our take on the strategy behind the smartest, savviest, and stupidest messages in the market today, and what you can learn from them. Our philosophy is, it’s not what you say, it’s what they hear. And that’s why we call this HearSay. I’m Michael Maslansky, CEO of Maslansky and Partners and author of The Language of Trust. And today, I’ve got Lee Carter our president and partner, and Katie Cronen, our partner as well, here to talk about a topic that I think can teach us lessons in a lot of different areas which we work. And we’re going to talk about, I don’t know, I’m going to call this the price of life, because we’re going to talk about pharmaceuticals, the pharmaceutical industry, the costs of medication, and the way that people react to those costs. What do you think? Did I make up a good name? Is that pretty good? That’s too pretty.

Katie Cronen:

Hehehe

Lee Hartley Carter:

I love it. And you know what? It’s pretty hard to put a cost on life, Michael. So that was clever what you did there.

Michael Maslansky:

Hmm. I try. I try. All right. So it is, uh, it will be no surprise to anyone listening to this podcast that pharmaceuticals and the pharmaceutical industry has had its ups and downs over the last couple of years. There have been moments of great success. There have been moments of challenge. Uh, and a lot of them have been around the cost of medications. And certainly, I think over the last couple of years, we’ve been living in the shadow of what happened during COVID. And so we’re going to delve into a little bit about what has happened with the industry’s reputation as a result of COVID and what the industry can do about it. And so  we’ve been doing research on pharmaceutical pricing for I would say 20 years now. And I can remember actually being in a focus group where we were talking about a new breakthrough innovation, a life-saving medication, and a woman stood up and said, this drug is literally keeping me alive and I hate the company that makes it. That’s what she said. And so, you know, as we think about the challenges that the industry faces today, I think that a lot of these challenges are longstanding. If we look at data, we can see that the industries had a negative reputation for a long time. But I do think that there was like an inflection point where it got really bad. And that was around 2015, where we started looking at what the real drivers were of negative reputation. And so Katie, I know you’ve looked a lot at what was going on then, and kind of like as we boiled up all the challenges that the industry faced pre-pandemic, that it came down to a couple of things. What were those things?

Katie Cronen:

Yeah, in 2015, we’re gearing up for presidential election cycle. And the out of pocket costs that Americans were paying for medicine was ranking really highly on the things that people were concerned about and cared about. Bernie Sanders as a presidential candidate gave it a lot of attention. We saw this trend evolve of talking about health care is a right and therefore it feels unfair to profit off of it. And we also saw bad actors like Pharma Bro and other companies being hauled in front of Congress and getting a lot of attention and having to explain where pricing comes from in medicines, especially when you have some companies who are seemingly jacking up prices for necessary medicines in a very, very short amount of time.

Michael Maslansky:

and so it seemed like there was a tremendous amount of pressure on the industry there. And yet, if we look kind of backwards, that may have been the last golden age of pharmaceutical reputation, with the exception of maybe the moment of the pandemic, right? So, Lee, what happened, that pandemic moment, which seemed like such a promising moment, why didn’t it turn out to be a real opportunity for the industry?

Lee Hartley Carter:

Well, it’s fascinating because, , one of the answers to the reputational challenge was how do you broaden the view of what happens in pharmaceutical companies? Because people think about the profit of the pill, but not the research that goes on the lab. So during COVID, we were all brought into the lab with the pharmaceutical companies and we were cheering for them. We were all saying, which one of you is going to get the vaccine to us faster so that we can get back to our lives? and we saw whether it was Moderna, Pfizer, J&J, AstraZeneca, all of the companies that had these promising vaccines with scientists in the labs, and we were really rooting for them. And it was an exciting moment, and people who were excited about the vaccine lined up to get it. It was like, thank you, Lord, for pharmaceutical companies for once. And it lasted a very short amount of time. And I think that the reason for that is it didn’t take very long for people to make the connection that, wait a minute, this vaccine doesn’t necessarily work that well in some people’s minds because there were a lot of people who, as soon as they got the vaccine, still got COVID so they couldn’t understand how well it worked. They saw how much the companies that did make this vaccine profited. And there was at the same time, a forcing of people to take this vaccine. So there were some people who got fired who wouldn’t take the vaccine. There were mandates. And we know that a lot of people really push back when you’re forced to do anything. And so instead of being happy and thankful to pharmaceutical companies, people felt even more beholden to pharmaceutical companies. And  they took this moment, so the idea that they put profits before people was amplified even more than it was before and things have got worse than they even were before.

Katie Cronen:

You know, what’s interesting too is I think that’s a really good encapsulation too of the general consumer sentiment. But even if you look at how physicians, how nurses and nurse practitioners felt how industry insiders started to feel toward pharmaceutical companies, they were very aware that prior to the pandemic, one of the most prominent defenses the pharmaceutical industry has been using about why medicines cost what they do is that R&D takes 10 years and a billion dollars and we fail more often than we succeed. That’s why this is so expensive is because this industry is so challenging. And they basically had a double-edged sword with the advent of the vaccines in a year because all of a sudden while it’s amazing and very necessary, you’re seeing, oh, pharmaceutical companies, you can do it faster than 10 years. You can be more successful when you really need to be. you can focus on prevention, not just turning things into chronic conditions. So is it just that you don’t want to the rest of the time?

Michael Maslansky:

This kind of brings together so many different strands of things that we see all the time, but you’ve got this desire to innovate and really this should have been a celebration of our incredible ability to innovate, but as you said, it kind of countered some of the beliefs or arguments that were being made by the industry. So it seemed like it kind of defeated other arguments for innovation. It was definitely politicized in a way that made it tribal to support or oppose and made the whole industry tribal in ways that I think, you know, I’ve seen some data on how reputation crises in a really a post-2016, post-pandemic world, if they are politicized, they are much harder to recover from than if they are not. And this was definitely a situation that was politicized. And that the focus of so many things was on the, what was kind of the deficit mentality, what the vaccine wasn’t doing, as opposed to what the vaccine was doing. But all of these really turned around, turned a situation that should have been really, as we talked about it, a new golden age for pharma into one that has almost amplified all the criticisms of the industry that existed beforehand. And so now as we look at data, the reputation of the industry is really in bad shape. And so our job is not to talk about how bad things are for an industry, but to figure out what they can do about them. And so what do we do? What does pharma do to overcome the challenges that they’ve been facing for the last, you know, at least a couple of years?

Katie Cronen:

One of the things that we’ve noticed in terms of how companies are currently responding, there is an instinct to be reactive and to go back into defensive mode where you’re explaining how much you invest in R&D, the effort involved, the idea being, let’s prove how hard it is so that you have a deeper appreciation for why you should support us. But there’s been another avenue of messaging where in a way that I think is more prominent than it was 10 years ago is to shift the blame to the middlemen, to the pharmacy benefit managers who work on behalf of insurance companies who, you know, the industry says they work to negotiate really large discounts on medicine, but then they don’t really pass those savings along to patients. They just are a middleman who is just taking their cut and driving up your out-of-pocket costs. And while I think it’s very tempting to try and shift the blame and point to a new villain, hey, we’re not the bad guys. Be mad at these middlemen. They’re the ones who are responsible for your pain. I think we see over and over again that it won’t work long term because while it may give your audience a new vocabulary for somebody else to be mad at, they’re still going to be mad at you.

Michael Maslansky:

And even does it work in the short term? Because I think we often see that blame shifting does not work. But in fact, there could be another villain to create that doesn’t look like you’re shifting blame. Right, Lee?

Lee Hartley Carter:

Yeah, and I think, you know, one of the things that we see when we’re working on issues like this, there’s often really principles of good storytelling that help shift the narrative, and that’s really what we’re trying to do. So what we have to do here is right now, we’re in this dynamic where it’s patients versus pharmaceutical companies. It’s the people versus pharmaceutical companies, us versus them. They’re the bad guys. We’re all struggling. So how do you recast that villain? So that instead of the pharmaceutical company being the villain, it’s actually the disease that’s the villain. It’s actually something else that’s a villain that we’re all on the same team. You actually bring all of us into the same team so that we’re rooting for the pharmaceutical companies just as much as we’re rooting for everybody else. And I think that’s one of the exercises that we need to go through. So what does that look like? Well, you know, trying to think of some examples from other industries or other places where companies have done this well. And we talk about this, there’s an advertising campaign by Roe over the summer. AndRoe is this online medical service, and they are treating obesity with a lot of these new injectable weight loss drugs. And there’s a lot of stigma around those drugs. And they did something really clever in their advertising and they changed the frame, they changed the way you looked at it. So the frame that they said or the line that they used is taking medicine for weight loss isn’t lazy, it’s healthcare. So what does it do?  it goes right on the face, it goes right to the problem, which is people, the stigma around taking medicine is that it’s a problem with the person. And it changes that, instead of it’s not a problem with a person, it’s actually a problem with their health. And that’s something that is medically that they can do about it. So by shifting that, you can shift the conversation. So really, how does a pharmaceutical company then shift who they’re looking at? And I think it’s such a good parallel example of how pharmaceutical companies really need to shift that question too, so that they’re looking at things differently.

Michael Maslansky:

Yeah, I mean, and arguably, if you’re in a debate about pricing, then you’re talking about pricing. And if you’re talking about pricing and kind of who the villain is on pricing, whether it’s the pharma company or the middleman, then you’re talking about pricing. And if you’re talking about pricing, you’re probably losing. And so the more that the focus becomes on something else, in this case, the benefits of the medication, the more successful you are likely to be, right?

Katie Cronen:

It reminds me of, do you remember the ad campaigns from years ago from Musinex and they personified this like mucus monster? Who was so gross.

Lee Hartley Carter:

Yes

Katie Cronen:

Like this mucus monster who camped out in your nasal cavity and was disgusting. Like, I think there’s something that’s the mental image that I want to apply to a challenge like this is stop personifying the middleman personify the disease that you have to go up against because I’d throw all my weight behind getting rid of that ugly disgusting mucus monster.

Lee Hartley Carter:

Any day of the week.

Michael Maslansky:

All right. Okay, so that’s one thing that they need to do is they need to make the condition the villain and talk about their ability to kind of defeat the villain. But they also don’t necessarily have a lot of credibility as an industry right now and they need to get people to overcome their own skepticism that anything that the industry says is going to be kind of biased or self-serving. So how are they going to do that?

Lee Hartley Carter:

Yeah, I think number one, when we’re talking to our clients that are in these kinds of situations, first you have to know that the skepticism is not going to go away overnight and not going to go away easily. It’s not like simply, you can’t just simply say, trust me, things are going to be different today. And so in these situations, we find that you have to disrupt thinking. You have to do something that’s powerful, some kind of a moment or symbolic gesture that allows people to see that you’re actually truly different in this moment. And one of the examples I’d love to think of when I think about how do you do a reset really well when you’re trying to really disrupt the way people are thinking. I think back to when Howard Schultz came back to Starbucks the first time he had left. And Starbucks had lost their way. And they had, there were a lot of criticism about the coffee flavor said that it wasn’t always consistently good and they didn’t have that same consistent Starbucks experience they used to have. The stores themselves weren’t all consistent. And Howard Schultz could have done what lots of people do is come back and say, I’m back, and we have a commitment to making great coffee again, and that’s what we’re gonna do. That’s not what he did. He closed the doors of every single Starbucks for an afternoon and said, I’m gonna train every barista how to make the perfect cup of coffee again. We’re going back to our roots, what we’re all about, just making perfect coffee. Now, that moment was a huge reset for Starbucks, and one we all remember, you know, 15 years later, because it was such a powerful reset. So then the question becomes, how can pharma do something that’s a symbolic gesture, whether it’s making sure that they have a transparent formula? We’ve talked to some pharmaceutical companies about saying, what are the four elements that go into pricing so that everybody can know what to expect each and every time? Is there some kind of a bill of rights that you could release that says, patients have a bill of rights around pricing and this is what we’re gonna do? Is there some other kind of symbol, and this might be something that we wanna debate what it could be.

Lee Hartley Carter:

But how they do something that goes beyond saying, this is what we have to do, it’s so hard for us. We’re bringing life-saving medicines, we’re all on the same team. You’ve got to do something to stop that thinking.

Michael Maslansky:

They’ve got to do something to disrupt. I mean, in some ways, what they did around COVID was an attempt at kind of resetting reputation. It was like, look at all that we can do when we put our minds to it. And that didn’t work, and that might discourage them from doing something else. Transparency, I think, is an interesting idea. Is that going to help them, or is that going to hurt them? And do they have the appetite, often when you’re going to do something very different, as was the case, I think, with Starbucks closing its doors, is there is risk involved in doing it and kind of taking a strong position and acknowledging, as he did, that the quality was not where it needed to be. If you’re going to do something that is symbolic, it often has to be kind of counter to your interest in some way in order to get to that other place. And the question is, you know, what is the industry kind of willing to do? If you go down the transparency route, there’s a lot that, from what I understand, is baked into pharma pricing, that some of which makes the drugs more expensive in a way that doesn’t help the pharma companies, some of which that might. And in simplifying it, do you risk creating a problem that’s worse? And so it’s a big challenge, I think, for the companies to think about even although I agree it’s the right direction to be thinking about.

Katie Cronen:

I wonder what it would look like if a company said they were going to open up a portion of their pipeline dedicated to research that was driven by what the public says they want them to research. If the narrative is that pharma chases whatever they can make money off of if you could own being the company that said, well, we give the public a say in what we try to bring to market next. I think that could be interesting and powerful. I think about, you know, if Starbucks closed their doors, is there some kind of advertising blackout that a company could do for a period of time to show that they’ll put that spend elsewhere. You know, just I think along the lines of what you were saying, Michael, it has to be something that feels very out of character in order to be successful.

Lee Hartley Carter:

And Michael, I think you’re right. There’s a huge risk with these things, but there’s also a huge reward if you get it right. And I think the thing that companies need to be really careful of is, you know, if you think about some of the things that are happening right now with government and, you know, the Biden administration taking credit for putting price caps on certain things, like insulin will never be more than $35 a vial now because they have now done this and companies are finding a way to profit. So if you suddenly go out there and say, you know, we’re gonna put a price cap on something, you’re running the risk that people are gonna say, hey, wait a second, what were you doing before, right? So you gotta be really careful and thoughtful about any unintended consequence of what you’re doing. But I think a couple of those suggestions that Katie had there were really smart ones because they get at not just the problem, but the root of the problem that could have some kind of a symbolic moment reset that allows people to, at least for a minute, listen to what pharmaceutical companies are saying, rather than push back on that same narrative.

Michael Maslansky:

So while we’re trying to figure out the great reset, what else? What else can the industry do if they’re not going to stop advertising, although I think that that’s a great idea to kind of shift the focus of DTC advertising at least for a minute and put it someplace else. What else could they do?

Katie Cronen:

One of the things that we’ve been talking a lot about is to focus on highlighting the tangible benefits of the work that they’ve done. I think there’s so much of an instinct to focus on the goal. Hey, we are looking to save and improve lives. We are tackling these kinds of disease states. And often, I think companies forget to show progress that they’ve made or to translate what those outcomes look like in a real personal, tangible way for people, even in terms of small things. And one of the examples of an organization that I think has done a pretty good job with this is actually NASA. They have a lot of storytelling that they’ve done dedicated to the benefits of space exploration. And it is not just about, you know, having a moon shot because going to the moon is cool. They are in a habit of talking about all of the things that the work of their engineers and scientists translates into for everyday people. You know, they talk about how what they did with food turned into Dippin’ Dots. They talk about how their standards for making sure that food was safe for astronauts on Apollo.

Michael Maslansky:

And thank God we have Dippin’ Dots by the way. I mean, because like.

Katie Cronen:

I know, I know. A trip to Six Flags is not complete without Diffendatz. But like NASA’s work on making sure the Apollo astronauts didn’t get food poisoning translates into the food safety standards that General Mills uses today. The work that they did in communication led to the first modernized conference call. They recently took their speed of engineering to create a patent that anybody could access for a new ventilator that doesn’t use any of the same materials that traditional ventilators use so that when we were running out of supplies we could manufacture new ventilators really fast. So the idea that they are translating everything they do routinely into everyday benefits for people makes a much stronger case about why you should spend a gazillion dollars, and yes that’s a technical term, on space exploration.

Michael Maslansky:

I mean, I think there’s something really interesting there in terms of things that have come out of the work that the pharmaceutical industry has done that were not direct benefits. But I also wonder, like, have, has the industry done a good enough job of creating a narrative about the impact that the industry has had on health? I’d say human health, but I think it’s probably really about health in the U.S. Because I think in many ways the narrative about health and health care in the U.S. is that we are getting less healthy than we used to be. And I’m not sure that that’s accurate. And I think that there are a lot of medications out there that really have changed the trajectory of health in America in really positive ways. And I’m not sure that story is being told. We are often talking about like how hard is it to make a new drug instead of look around and see how lucky we are to be alive right now, to quote a certain Broadway show. Lee, what do you think about that?

Lee Hartley Carter:

I think it’s such a good point and that’s a really good reframe. How do we reframe it around those things that are really practical, tangible benefits that we feel every day rather than it just being about the moonshot of going after cancer or Alzheimer’s? And it’s interesting because we’ve done so much work for different therapeutic areas over time, having nothing to do with pricing. Just how do you talk about a new medication or a therapy that is gone from twice a day dosing to single day dosing or something that was once an injection to something that is now a pill. I remember we worked on a cancer therapy that was non-injectable and that suddenly became a huge benefit to patients, not just that you were saving their lives, but also that they didn’t have to go through the agony of injections and the IV process. And so I think sometimes we take for granted the smaller things, but it’s the smaller things that makes our lives better each and every day. And when you start to appreciate all of those different things, you start to appreciate the companies that are behind it and the people who have thought of them. And it doesn’t always have to be those big, huge things. It can be the smaller things too that just make our lives better.

Michael Maslansky:

Yeah, I think that that’s absolutely right. But I think all of this kind of reveals the fact that it does seem like the industry spends a lot of time talking about the individual kind of breakthroughs and cures, like for an individual medication, and then the challenges of creating that next one. And that,  at least from my experience, you used to talk about cancer being a death sentence. And now it’s like, well, what kind of cancer is it? What stage is it? What treatments have already been offered? And if you leave cost aside for a second, as important as that is, like the number of people who are able to benefit from some breakthrough innovation in oncology or immunotherapy or one of the great innovations that has happened at large, there is nobody telling that story. In a way that I think is breaking through, where people just look at cancer in a totally different way. They look at HIV in a totally different way. They look at hep C in a totally different way. They look at all of these things that were life-ending, and now they are life-changing, but not necessarily life-ending.

Lee Hartley Carter:

Mm.

Michael Maslansky:

And yet we also know that, you know, it’s a lot of research. It’s going to take, you know, we have to support innovation I’m just not sure how much that argument really helps build reputation and it may yet in fact be contributing to the negative so we can talk about how far we’ve come. We can talk about progress and momentum. We can make it tangible. If you’re advising one of our clients or others in the industry, what else? Is there anything else that we can talk to them about to help them strengthen their reputation?

Katie Cronen:

The other thing that we talk about a lot is this challenge of how often we associate the medicine with just a pill. A pill that you pay hundreds or thousands of dollars for that you need monthly at your pharmacy. And the limitations behind that is that it just looks like something that doesn’t necessarily seem to have a lot of value in it when it’s when it’s viewed as just one simple product. And I think the question for the industry is, how can we credibly and meaningfully expand what it is that the industry does in people’s minds to shift away from just being a product, but to actually offering services or a service that improves the quality of your life.

Michael Maslansky:

And how would we do that?

Lee Hartley Carter:

If you think for a minute about the financial services industry in 2008 after the financial collapse. There were a lot of financial services companies that were trying to do all the things that we’ve talked about. They were trying to distance themselves to the problem, say we weren’t the ones that took bailout funds, we weren’t the irresponsible actors, it’s not our fault, it wasn’t us, it was these other guys,  But I can remember very, very vividly, we were working with one financial services company in particular and we had to convince them to stop all of that. The answer isn’t in helping them appreciate that you’re not part of the problem. The answer is making them appreciate that you are the solution. What do I mean by that? The language that we tested that worked was there are a lot of things that led us to this moment, and we’re not here to debate them. What we are here to do is talk about how we are going to set the financial services industry right going forward so that you know that your money is always going to be safe. They’re always going to know exactly what you’re getting into when you get a loan from us that you’re always going to do these kinds of things. Now here’s what I think that example is so powerful doesn’t go backwards, it goes forwards. And it starts to say, wait a minute, when you start listing out the different things that the financial services company is doing, it is actually an important part of my life. I actually need financial institutions to do well. I want them to do well because they’re part of the solution in the future. They can keep my money secure. They can help give me loans and help me buy homes. They can help me do all of these things. They can be a supporting actor in my life that’s really, really important. But I start to appreciate all those things by listing it, rather than going after and debating them. And so suddenly you start to view in this one statement, the company not is just trying to push product or trying to push savings accounts, credits, cards, and loans into something that actually is providing invaluable service to you. And so pharmaceutical companies, instead of trying to debate this issue, how do we talk about all of the things that they’re doing for us? They’re actually inventing life enhancing services. It’s a total surround that’s important every part of our day and every part of our life.

Michael Maslansky:

Yeah, I think that’s a great reframe and one that not only applies to pharma, it applies to many other kind of reputation challenge situations. But I think all this, you know, it seems like it comes back to this idea of where is the industry kind of focusing its attention and its messaging? And all the answers seem to be separate and different from kind of defending, explaining, blame shifting on pricing. It’s all about telling a different, broader, more emotional, more effective story about what it is that the industry delivers and that there is a tremendous amount of, I think, fighting that goes on inside the healthcare industry overall between the government and doctors and payers and pharmaceutical companies. You may not be serving any of them well. I am a believer that all of this innovation, it certainly is costly and we’re leaving aside kind of the international element of things about how they price things. But you know, I do think that I don’t want to be sick, but if I had to be sick, I’d rather be sick today than I would yesterday. And that every day we are better able to address these just incredibly complex medical conditions in ways that were never possible before. And I know the industry talks about this stuff, but it seems like there are opportunities to look at it in a different way, because it doesn’t seem like that message is getting through.

Katie Cronen:

Well said.

Michael Maslansky:

Well, thank you.

Lee Hartley Carter:

Call us to help. Ha ha ha.

Michael Maslansky:

Exactly.

Lee Hartley Carter:

One final point that I’d like to make is, it’s interesting that pharmaceutical companies can be so demonized when we all have personal stories on how powerful and important they have been to our lives. And I think for all of us that have worked on these kinds of issues, we all have our reasons and our stories on why this could be so important to us.  I think one of the things that is going to be really important to all of this is making big corporate America seem relevant and personal to me, and it’s possible to do that. and in one of the ways we thought that the right way to do that was to bring the scientists into our living rooms. So we started to see scientists instead of executives. But that happened during COVID. And so now I think there’s the next generation of how do we make these big, impersonal, corporate, greedy giants relevant and personal to us in the ways that they are in all of our lives thinking about it? So I think it’s a really important challenge and one that can be done, even though it seems impossible at times.

Michael Maslansky:

I think that’s a great point. And it also kind of reminds us that pharma has become kind of tribal, that there are people who are for it and who are against it. And that’s why some of the things that maybe used to work are not working as much and that the, that maybe if we all can find ways to, the things that we agree on, like health, like advancing the health of people we love in ways that are personal and different from what’s been done before, that maybe we can overcome the politicization of the pharmaceutical industry. And certainly something that we can hope for. And it’s been super interesting. Thank you, Lee and Katie for educating me on all this work that you’ve been doing in the pharma industry. And thanks to our listeners for sticking around with us for this, for more language insights and to be in the loop on all the other fun stuff we’re doing. Follow us on LinkedIn at Maslansky and Partners. That’s all for now. Stay tuned for more episodes of HearSay because when it comes to truly effective communications, it’s not what you say, it’s what they hear.