Trust has hit a new low for pharma in Edelman’s annual Trust Barometer survey. The 13-point drop from 51% to 38% in the U.S. was the category’s biggest plummet in the five years the public relations and marketing firm has been tracking sentiment.

Plus, it’s a turnaround in the wrong direction. The big nosedive comes just one year after pharma showed gains of four points in U.S. consumer trust.

While pharmaceutical companies saw the most notable drop, trust fell across the board in all healthcare categories in this year’s U.S. survey. Edelman looks at five healthcare subcategories: pharma, biotech, payers, hospitals and providers, and consumer health.

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Biotech saw the next largest drop in trust after pharma, falling by 9 points. At the other end of the scale, hospitals and providers only dropped by 1 and remained the most trusted in healthcare with a score of 70.

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Pharma’s score of 38 puts it firmly in distrusted territory, while scores in the 50s in previous years had pegged it as neutral. Overall trust in healthcare in the U.S. fell by nine points, down to 53% of consumers, which made it the least trusted of the 15 industry sectors that Edelman studies. The global score for pharma—as opposed to U.S.-only—remained neutral with a score of 55.

“We think what may have happened this year (for pharma), in particular in the United States, is that the backdrop over the uncertainty over the ACA, the opioid epidemic, pricing and the whole healthcare blame game that’s going on in terms of pricing and access, probably had an effect on the trust scores,” said Susan Isenberg, global health chair at Edelman.

The high cost of healthcare in particular was blamed on the pharma industry, Edelman's research found. In both the U.S. and globally, the majority of respondents agreed that pharmaceutical companies put profit ahead of patients.

However, there are things pharma companies can do to try to repair that trust, she said.

As a communications company, Edelman naturally put forth suggestions centered on getting the word out. Communicate stories about innovations and solutions, Isenberg suggested, and stay away from placing blame on the industry’s challenges. Talk about the ways your pharma company addresses the whole patient, instead of focusing your messages only on the product or treatment, she said.

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She also advised companies to use a variety of communications channels, including their own digital properties, to tell stories. Tapping their own people to participate works well, too.

“It’s important that pharmaceutical company also look at the different people who can help them tell their stories. Employees, experts and scientists—those are the people who can help them in terms of regaining trust,” she said.