After my last blog post on the subject of the Makena controversy, I got an email from Doug Staples, SVP of Strategic Marketing & Communications for March of Dimes, asking if he could try to answer some of my outstanding questions about the organization, its role in the controversy, and its response thus far.
I called Doug this afternoon and we had a nice chat. He put forth the premise that getting FDA approval of the drug to make it an official use, allow it to be mass-produced for all patients, and allow it to get on formulary with all plans is a good thing. I agree, as I have since heard of women who were not able to get doctors to prescribe 17P because it was not an approved use of the drug, or were unable to get it because it was not on formulary (and had no choice in changing doctors because there were no other doctors in their rural areas). March of Dimes figured that there would be a price increase, but they didn’t realize that it would be as astronomical as it was. Doug also admitted that they had put too much stock in K-V’s assurances that its Patient Assistance Program would ensure that all women who received prescriptions for Makena would be able to afford it.
Regardless of whether or not I think that this indicates a realistic worldview by the March of Dimes analysts, it at least provides a window into what their thought process was.
Now that I had determined what the purported reasons for their participation in the debacle were (which, in my last post, I labeled as “poor strategic insight” and “naïveté”), I turned to their limp, delayed reaction after the price became known. Doug told me that March of Dimes had still been going on the assumption that the Patient Assistance Program would take care of the cost for mothers who needed coverage, and that they had tried working behind the scenes to address the problem, but had not been successful.
I suggested that this was not the fiercely advocating March of Dimes I had come to expect, and that I was extremely concerned with the lack of public response.
Doug was also surprised that women were being told about high copayments when, to his knowledge, nobody should have been prescribed Makena yet. He said that expectant mothers already on 17P should be able to continue their existing course of treatment, and that only new patients would be getting Makena. He also said that no negotiations had taken place yet with insurers and other payers over the price that they would pay. He likened the $1,500 cost per dose of Makena to the list price of a car, and said that it was likely that none of the insurers or other payers would actually end paying that price.
I suggested that one course of action for the March of Dimes should be to take a number of test cases of mothers who had been given high copayments by their insurers and help them through the process to see if they would get assistance with the copayments. I also suggested that more forceful action may still be necessary.
Doug agreed that working with test cases was a good idea, and said that March of Dimes will be meeting next week with K-V to discuss the pricing issues and will see if they can resolve the issues in a collaborative fashion. He also indicated that, as I had suggested in the comments to my first post on this topic, if necessary March of Dimes might decide that they have no choice but to break their contract with K-V and return their donations in order to be able to take a more adversarial approach to resolving the situation.
I do believe that often collaborative problem solving provides better outcomes than confrontational problem solving, but that sometimes confrontation is the only way to break a logjam. I’m glad that the March of Dimes is showing a willingness to throw down with K-V if necessary.
Of course, this is good talk, but we haven’t seen action yet. Doug seemed very anxious to hear my opinions, and responded positively to my suggestions. (It sounded like he was taking notes while we talked, as well.) I told him that I was going to continue to sit on the sidelines for another week or two before deciding whether to start fundraising in earnest for this year’s March for Babies or give up on the organization, and he thanked me for my commitment and for taking a collaborative approach.
But that’s words. Let’s see some action.
I know that some would have wanted me to take a more confrontational approach. I did call the March of Dimes out for its ineffective and limp actions to date, and Doug largely agreed with me. I also think that Jen Gunter has some good questions for the March of Dimes. It’s probably a good thing that we’re working from opposite ends on this. By having some confrontation and some collaboration, we can work both inside and outside the box. Perhaps the March of Dimes, ACOG, AAP and SMFM need to do the same thing. Pick sides, and have some attack strongly from the outside, while others work fervently from the inside. Perhaps a coordinated inside/outside approach will help K-V to change their pricing and stand by their PR for the Patient Assistance Program.
For now, confronters please keep confronting. I plan to continue collaborating. If I don’t see movement, I will be calling Doug back. Let’s see if together we can get some movement going in the right direction, and then build momentum. Let’s bring the March of Dimes back onto firm advocacy grounds from the helpless, limp position that they have put themselves in through this contract with K-V.
Since they appeared to be open to opinions and advice, I’m going to give them the benefit of the doubt for the next week or so. But that’s it.
What do you think? Confront? Collaborate? Both? Will the March of Dimes do what it needs to do, or will it continue to take the money and run?