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It is always fun to hear pundits make predictions. Most of the time they are wrong but we eagerly watch experts tell us who will win elections, how much stocks will rise, what the price of oil will be, and which film will win best picture. We have a media that exists to debate these issues 24/7.

So why should I miss out on the prediction game. I really have no way of knowing what will happen in health care, DTC spending or regulation. I do, however, have an informed opinion on where we might end up. So, for what it is worth here goes for 2017.

1. DTC will continue to thrive no matter what the politicians decry about greedy drug companies. We have the first amendment and DTC generally works well as a promotional strategy. True, Congress knows the drug industry is an easy target. They also know that drug marketing employs lots of people in their districts. So they will huff and puff but in the end not adopt any rules to make drug ads harder to execute.
2. Trump is a real wild card as far as drug pricing actions. He may threaten drug companies with Medicare price negotiation and actually mean it. On the other hand Trump knows that forcing prices down could hurt jobs and innovation. More likely he will arm twist drug CEOs to pricing self restraint and then tweet his victories.
3. Obamacare will be drastically altered to be more free market. Mandated coverage will be eliminated and consumers will have more choices what, where and how to buy insurance. Republicans will replace it slowly, however, and be very cautious throwing currently covered Americans off the insured rolls. Free market policies will shift the burden of health care decisions more to consumers and this has numerous marketing implications for drug companies. Price/value will be something drug advertisers must consider in their messaging.
4. The FDA will get an overhaul to be faster decision makers on new drug approval and hopefully that will include the glacial moving OPDP. Nothing against the generally nice folks who work there but please try doing research that actually gets done in a timely fashion. Also, the social media train left years ago but OPDP cannot seem to accept consumers know how to easily one click to see warnings and risks.
5. DTC media mix will continue its evolution towards social media and point of care, but nothing indicates that mass media will decline. Drug companies have better mass media targeting tools and that means getting more effectiveness. In fact more specialty brands are using television because the mass awareness, although inefficient, still brings in enough new customers that justify the expense.
6. Media consolidation is happening in new media. There are starting to be mergers and acquisitions that will eliminate a whole lot of smaller players. Having bigger companies will make it easier to buy larger physician and patient coverage in Point of Care and Internet media. Drug companies like to one stop shop so expect more dollars allocated the easier it gets to buy large scale.
7. Expect more drug company corporate media and DTC advertising efforts to justify drug prices. There are valid reasons for high prices in most cases, but Americans are perplexed why they pay more than other developed countries. It is a very tough sell but Americans are demanding to know what the premium price is getting them.

2017 will be an exciting year for health care marketers as change always breeds risks and opportunities. We have not had such uncertainty since 2009 when Obamacare was formulated.

We are likely to see a much freer market for health care under the new Trump administration. What does that really mean for consumers and providers? How might it affect drug companies? And to those of us in DTC marketing, does a free market help or hurt our business?

America is not currently a true free health care market and has not been for over 50 years. Our someone else pays health care system has made users of health care unaware of costs. Is my service or procedure covered is what we ask. What is my co-pay is what we care about. Our providers make more money when they do procedures and tests. Patients readily accept this extra care as long as it is paid by insurers.

Our government has made our system extremely complex with its variety of programs and regulations. Medicare, Medicaid, The VA, HIPPA, The ACA, the 50 different state requirements, and a myriad of other public and private agencies oversee the most opaque system in the world.

What if we went to a free market where what we spend is truly our money and costs matter? Assume the government gives you a stipend through a tax credit or a cash payment. That is what you have to spend on your healthcare subsidized by government. Anything beyond that you pay. Regulations are loosened to allow you to buy whatever insurance you want, anywhere from an approved company in the 50 states. Health care providers must compete on providing quality care at a price people can afford for services they really need.

Drug companies will need to justify price premiums because consumers are now deciding where to allocate their limited available funds. Insurance companies who are competing on offering low premiums will want to squeeze drug companies as much as possible. That means consumers will have many drug coverage options to choose from and they will not pay higher premiums for me-too drugs. DTC advertising will need to deal with price/value issues.

What about people with pre-existing conditions? This is a complex problem. After all, signing up for insurance generally assumes the negative event has not happened yet. None of us get to buy car insurance after we total our car. So what we need is some way to help people with pre-existing conditions to get help on their costs. This is not insurance, it is compassion from society that prevents people from going bankrupt or dying because they cannot afford care. Instead of calling it insurance and forcing companies to cover these folks, it makes sense to create a special high risk pool subsidized by government.

A true free market is a hard but a doable thing to implement over a decade or so. It means treating health care like other consumer products and shifting purchase decisions to the patient. If prices are transparent, and quality measures are readily available for providers, consumers will make rationale choices.

Free markets give consumers incentives to stay healthy as the cost of prevention are lower than costs of treatment. Many critics say health care is a right better managed by government. They may be right as some developed countries do it well. America can go either way but cannot continue its current system which is neither free market or single payer. Under a free market system we would unleash tremendous forces of innovation that could do great things for patients. It will be a hard road to truly get to a real free market but it is worth a try. After all, that “someone else” paying is really us through higher taxes and insurance premiums and deductibles.  We are paying higher per capita for health care than anyone else in the world so we must consider real change.

In an attempt to mandate lower drug prices California is asking voters to mandate state agencies pay no higher than the Veterans Administration (VA) rate. The VA gets lower negotiated rates than most other payers by as much as 40%. The VA has a formulary and dictates the prices it will pay. Proponents of Prop 61 say it will lower drug prices because it says drug companies can only receive the lower VA price.

It sounds nice but price controls rarely work in practice. Drug companies do not have to sell to anyone. They may just decide the VA price is just too low to justify the sale. Californians may miss out on those newer drugs that drug companies refuse to sell them at the VA price. The VA because it negotiates these low prices does not provide veterans with many of the newest drugs.

Drug companies may face this type of bill in other states. That means they may decide not to sell to the VA at current prices because they know it is the new benchmark used by the states. Therefore, they may play hardball with the VA and thus veterans may not even get the drugs on the current formulary.

Drug price controls sound great but proponents think that they can dictate prices to drug companies and nothing will change. Drug companies will respond by refusing to sell at government mandated prices, or try to raise prices elsewhere to compensate. Anytime the government tries to mess with free market prices problems arise in supply. Liberals, who usually have never run a business, seem to think that the profit motive is ethically wrong. They feel they can decide what a company should make in profit.

Maybe some drug companies will sell California its drugs at VA prices. Many will just forgo the sale knowing the slippery slope they face in other states if they cave to California. Citizens have legitimate concerns over drug prices but price controls have unintended consequences that will reduce choice for those citizens. Prop 61 may pass but it will not be good for Californians when they see newer drugs are no longer sold to them at mandated bargain prices.