Addressing the issue of medication adherence begins before a patient even fills their first prescription. According to a recent IQVIA analysis, only one in four patients who were new to a brand in 2021 successfully initiated therapy.
“To put this into perspective: if all of the patients were 100% adherent, then at most the brand would achieve 25% of the TRx volume that their sales team successfully had physicians write,” explains Josh Richardson, Chief Commercial Officer, Prescryptive Health. “Now layer on the actual adherence rates and the challenges loom larger than ever.”
Those challenges are particularly heightened among patients who are prescribed biologics, which are a growing therapy segment representing 42% of total spending in the medication market, according to Luke Forster-Broten, Director of Product Management, Life Sciences at Phreesia.
“The biologic patient journey is particularly fraught—patients are often unprepared and/or under-supported to navigate the specialty pharmacy process, prior authorization, financial burden, novel methods of drug administration, and consistent monitoring such as labs or check-ups,” Forster-Broten says. “As a result, biologics often see 30% to 40% initial medication abandonment because of therapy delay and confusion.”
To address these barriers, Forster-Broten says companies are developing specialty hubs that provide comprehensive medication adherence programs with services including coverage support, personal nurse coaching, refill reminders, and mobile apps. The caveat: only 8% of patients have ever used these hubs, according to research from Phreesia.
“As patients are largely unaware of hubs, it often falls on the overburdened provider’s staff to educate and enroll the patient as part of an already complex and largely manual specialty medication initiation process,” Forster-Broten adds. “To drive enrollment, provider staff need support to digitize and streamline patient education, communication, and specialty initiation document collection within an interface they already use.”
On the patient end of things, Julie Van Inwegen, VP, Business Development, Adheris Health says it is not enough to simply offer a digital connection—you have to provide an engaging, meaningful, and individualized experience.
“In a recent study, 50% of healthcare consumers reported that a bad digital experience with their provider ruined the entire experience while 39% felt that a good digital interaction had a positive influence,” Van Inwegen explains. “Utilizing user insight to create a thoughtful user experience is key to developing successful digital health solutions. Connecting live interactions with a seamless digital interaction that provides meaningful and personalized content and resources or rewards, will drive adoption, continued use, and trust in that brand.”
Improving Adherence with a Human Touch
Andrea Heslin Smiley, President and CEO, VMS BioMarketing, believes another reason behind the low adoption rates of hubs and other patient support programs is that too often life sciences companies treat patient engagement as an afterthought.
“Programs are often ‘bolted on’ to existing services versus designing them specific to the needs of patients,” Smiley says. “Technology alone cannot replace the emotional intellect, context, creative thinking, and relationship building that people can bring to patient engagement. The industry needs to personalize patient support utilizing predictive analytics, preferences, and assessments to design an individualized patient experience instead of a one-size-fits-all model. Real-time data sources may then help adapt the patient’s support program and trigger just-in-time interventions.”
In order to best combine high-tech and high-touch solutions, it is important to first understand the barriers keeping an individual patient from starting or staying on therapy. To do that, Jessica Lens, Chief Patient Experience Officer, CareMetx, suggests broadening the scope of what we consider “adherence.”
“Including all medication-taking behavior, specifically product initiation, will help us build a stronger foundation for longer term adherence and persistence to therapy,” Lens says. “It’s also critical we solve for the entire patient experience by engaging deeper with patients’ psychosocial needs—motivation, expectations, resilience, social support, etc. Part of this effort must include a consideration of social determinants of health (SDoH)—food, housing, transportation, access to care, etc.”
Eli Phillips, Jr., PharmD, JD, Vice President and General Manager, Digital Health at Outcomes, a Cardinal Health Company, suggests deploying patient surveys and patient-reported outcomes studies to assist healthcare providers with detecting and correcting some of the more hidden causes behind a patient’s non-adherence.
“In order to select the most appropriate intervention, it is more important than ever to recognize that the level of engagement in one’s own healthcare varies from patient to patient,” Phillips says. “While some patients may value the in-person interaction they receive from healthcare providers, others may gravitate towards a more self-directed approach dependent on digital tools, such as dosage reminders. Further confounding the issue, patient needs may change over time. Therefore, the most successful approaches will be adaptable and capable of identifying shifts in the patient’s needs as they occur.”
Growing Trends in Adherence Support
What else are life sciences companies doing to revamp their current adherence strategies? For one, they are expanding the role of pharmacists in patient support activities, according to Patrick Hawthorne, RPh, SVP for EHR and Pharmacy Partnerships, ConnectiveRx.
“The movement to expand the clinical role of pharmacists is especially pronounced in patient counseling responsibilities, including medication therapy management (MTM),” Hawthorne explains. “Broadly defined, MTM is pharmacist-led support for patient/caregiver awareness and adherence to medication therapies. For example, if a prescription is dispensed for an inhaler, the MTM session might include a patient-pharmacist interaction in which the pharmacist demonstrates the proper assembly and use of the inhaler and provides MLR-approved instructions and support.”
Predictive adherence is another emerging trend within the life sciences industry, especially during clinical trials.
“By leveraging AI to analyze video and audio data and directly observe patients taking their medication via smartphones, clinicians can track patient dosing behavior over a two-week placebo period before a trial even begins,” explains Rich Christie, MD, PhD, Chief Medical Officer, AiCure. “Because a patient’s future behavior is usually consistent with one’s past behavior, trial sponsors can gain valuable insight into the pool of potential participants and identify those who are unlikely to adhere to the study or are likely to drop out with high accuracy.”
Finally, when you consider that one in four patients take three or more prescription drugs, according to the CDC, Aaron Crittenden, GM of Manufacturer Solutions at GoodRx, says it’s time for life sciences companies to make an important adjustment to their adherence programs.
“Currently, adherence solutions or other patient support solutions are brand-specific and may offer approaches that are highly drug-specific,” Crittenden says. “Successful solutions need to evolve beyond tackling adherence for a single medication to a more holistic solution that addresses multiple medications, managing the condition, co-morbidities, and overall health outcomes of patients.”