New programs from GSK, Novartis, and Pfizer stand out in an industry that has hurt itself by failing to proactively address the issues of pricing and access. While some question the extent to which the new discount card initiatives will truly help seniors get the drugs they need, officials at all three companies say they hope to inspire other companies to step up their efforts in the area and, in doing so, give the industry greater leverage in helping to shape a Medicare drug benefit. Similarly, Novartis sees its sliding-scale pricing scheme for Gleevec as setting a precedent for itself, and its competition, to insure that novel, lifesaving therapeutics will be affordable for those who need them. These programs may also serve commercial ends. The cards provide sales reps with something new to talk about, helping them to reach more physicians and increase the length of their office visits. And Gleevec's sliding scale pricing segments the patient population according to income in a way that will arguably maximize profits; it could also help boost Novartis' oncology franchise by strengthening ties with oncologists who can be sure their patients will get Gleevec when they prescribe it.

Physicians are joining together under unified management structures to become more efficient, able competitors in an increasingly capitated world. Efforts are farthest along in the lucrative and growing market for cancer treatment, but specialty physician groups of all kinds are moving to stake turf and sell their services to managed care. Information technology will be key to balancing quality and cost--and proving it.

While financial institutions such as banks typically spend 10-12% of their revenue on information and insurance companies as much as 6%, health care institutions spend an estimated 2%. Where does growth lie in information services?

Zeneca, in tying up with Salick, won’t in the near term build up sales volumes of its cancer drugs. It’s hoping that Salick’s database will provide product-differentiating information for its pharmaceuticals and let it explore the service business, which, in a capitated system, could increase in profitability as pharmaceuticals shrink. And while Salick's facilities-based approach to cancer treatment means its system will be more difficult to expand than a facilities-independent cancer management system, it could also provide a template for disease management in other therapeutic areas.