Adherence: The Next “Blockbuster”

While the day of the blockbuster pill died with Lipitor going generic, the days of non-biologic oral therapies are numbered. In past few years, the number of samples in my closet shrank dramatically as my most commonly prescribed drugs have gone generic or OTC. The majority of branded medications I receive samples of are some of the newer diabetes agents and respiratory medications (which are difficult for generic companies to get approved—and thus will likely stay branded for some time).

While therapies developed from biotechnology are certainly the next wave of innovative pharmaceuticals, many of these products are years away from becoming available and will be limited in use for more severely affected patients who fail standard of care. Thus, pharma companies who make branded maintenance medications that are not likely to go off patent in the next few years would be wise not to lose focus on these medications.

Pharma’s Help Is Needed

Due to the lifecycle of most existing products, research on efficacy, safety and comparability is extremely limited and it is now a rarity when my pharma rep provides any useful new data. However, one area where the industry could help me—and my patients—is with adherence.

It is well known that adherence to most medications is abysmal. Regardless of the products companies make or what physicians recommend, efficacy is substantially diminished if patients aren’t adherent. While research on comparative effectiveness is a potential risk for the pharmaceutical industry, focus on adherence is essentially a risk-free complete return on investment—and should be considered the next “blockbuster” for the industry. There are many areas in which the industry could leverage their resources and improve adherence.

1. Disease state awareness. Patients will often not take medications—and providers will often not prescribe them—if neither understands how the medications work. Focusing on how medications work in the context of the specific disease state would go far to improve adherence.

2. Availability of medication. Patients will not take medications if their insurance doesn’t cover them or the co-pay is too high. Coupon programs reward adherence (money saved increases with adherence).

3. Research on adherence. Most pharmaceutical research focuses on NDAs and sNDAs. However, many questions go unanswered as to why patients do not take their medications. And evaluations of innovations that improve adherence are needed.

4. Technology to track and monitor adherence. Evaluations of innovations in adherence, tracking and monitoring patient medication use is critical. Pharma could even partner with insurers who also have a vested interest, and employ patient databases.

5. Innovations to improve adherence. Innovations could be as complicated as sensors that integrate with personal electronics or as simple as daily reminders. Innovations that lead to adherence also include making medications easier to take: Providing better pens for injectables, easier-to-use respiratory devices or medications that no longer require monitoring.

The pharma industry—with its large research arm—is well positioned to lead in this area.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at


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