Solving the Adherence Problem

Nonadherence to medicine is a problem. I am sure you have heard the numbers, but here is brief refresher. The Credit Suisse report, “What if Patients Actually Took Their Drugs: Assessing an Underappreciated Opportunity,” published in March 2018, found that up to 30% of prescriptions are never filled and as many as 50% of people with long-term conditions stop taking their medications within the first year. Meanwhile, a research paper co-authored by Capgemini and HealthPrize Technologies published in 2016 found that pharmaceutical revenue loss in 2015 due to nonadherence reached $250 billion in the U.S. and $637 billion globally.

So, yes, nonadherence is an issue pharma needs to address. Which isn’t to say the industry hasn’t been trying. It is just a hard target to nail down, considering the myriad of reasons behind nonadherence.

“We see several barriers to medication adherence, such as the inconvenience of frequent trips to the pharmacy, failure to use prescriptions before expiration, and varying doses that can confuse patients, but perhaps most troubling is affordability,” explains Alison Wistner, CEO at UpWell Health. “According to UpWell Health’s recent True Cost of Diabetes survey of more than 5,250 patients, 45% reported sometimes going without diabetes care and medication because they couldn’t afford it.”

For years, pharma has believed the two main causes for nonadherence were cost and forgetfulness. To counter that, they offered copay cards and other patient assistant services to help with financial issues or to offer reminders. But, those may not be the biggest barriers to adherence, according to Kate Perry, PsychD, Director of Behavioral Science, Atlantis Healthcare.

“Overwhelming evidence suggests that the most consistent barriers to medication adherence relate to a person’s health beliefs, including those about their condition (i.e., how long will it last, how can it be controlled) and their treatment (i.e., how necessary is the treatment, how concerned are they about the treatment),” says Dr. Perry. “Reminders and cost/access support do not address these barriers. Critical to creating a successful adherence program is recognizing that a one-size-fits-all approach does not work.”

What Adherence Programs Work?

So then, if reminders and financial support aren’t enough—and one-size-fits-all approaches fall short—what can pharma do to better address this issue?

“A good adherence program should deliver a unique experience tailored to individual patient needs,” says Kara Quinn, VP of CRM at Klick Health. “First, marketers should map out the journey from the patient’s diagnosis through to ongoing therapy. Next, outline the content and tools needed to overcome each barrier. Additionally, creating support communities and recognizing small accomplishments are other important program integrations that help patients accept and understand their disease and ultimately deliver a program that has heart.”

Luckily for pharma, more personalized programs are becoming easier thanks to the latest technology.

“Using predictive modeling and AI, brands can engage micro-segments of patients with precise messaging at key moments where an adherence intervention will have the greatest impact,” explains Mark Schulman, Head of Customer Insights at Crossix. “This data-driven, personalized communication allows brands to better profile, reach, and engage health audiences to support them throughout the patient journey.”

New technology may also help patients to better understand the barrage of information being thrown at them about their disease or medication.

“Shutting out the external stimuli and immersing HCPs and patients in an educational VR experience allows them to focus on and retain what is important to maintain and improve health and adherence,” says Brian Peet, President of MediSolutions. “VR opens patients up to this by calming the mid-brain and stimulating the pre-frontal cortex, allowing memories to form better than conversation alone.”

But pharma can also use a more personal touch through behavioral coaching techniques that could be initiated through hub services or copay offerings.

“Research shows that behavioral coaching is effective and that frequent, personalized interactions with patients create opportunities to reinforce messages about adherence,” says Amanda Rhodes, Director of Client Strategy and Solutions for McKesson Specialty Health. “Results also demonstrate these personal conversations create opportunities to encourage patients to play an active role in managing their own healthcare while increasing adherence anywhere from 10% to 25%, and even as much as 40%, depending on the therapeutic class and associated patient and product challenges.”

Is Your Adherence Program Working?

Even if pharma takes a different approach, how do you actually ensure it is working? Sachin Makani, PhD, Scientific Director at Virgo Health suggests adopting a similar approach to the Apgar score. In 1953, Dr. Virginia Apgar proposed a simple 1-10 score for evaluating the basic health status of a newborn.

“Apgar is effective in part because it costs little time to administer,” explains Dr. Makani. “A tool measuring adherence could be similarly easy to implement. For example, a validated 8-point (yes/no) questionnaire published by Morisky et al. in The Journal of Clinical Hypertension (2008; 10(5):348-54) would add to a physician’s informational arsenal without adding significantly to her workload. It would also allow one to assess whether any given adherence intervention is working.”

Of course, you can also look at the numbers.

“Based on recent Adheris Health research, we have found three indicators keenly related to adherence: High void rate, the percentage of patients who only fill their chronic prescriptions once, and days of therapy prescribed,” says Mike Skovira, RPh, President of Adheris Health, a Syneos Health company. “Evaluating a brand’s patient population for these factors can identify non-adherence patterns that lead to suboptimal patient and brand performance.”

Pharma can also partner with payers and HCPs to better keep track of what is going on.

“The growing utility of real-world evidence and health economics and outcomes research data provides opportunities for pharma to collaborate with payers and HCPs to include clinical outcome endpoints that probe disease- and drug-specific factors,” offers Michael Pucci, RPh, PhD, CMPP, Senior Scientific Director at Lockwood. “Likewise, there is tremendous potential for improved data accumulation and dissemination through smartphone technologies that assist HCPs, patients, and caregivers with patient-centric factors.”

However, in the end, maybe the solution isn’t better adherence programs, but better drugs.

“The future is in drug technology,” offers Jay Carter, EVP, Director of Business Development, AbelsonTaylor. “The pharma industry in the 1960s to the 1980s developed products that reduced the dosing of key products from three times a day to twice a day to once daily. Improvements in adherence ensued—not with programs, but with technology that permitted the motivated patient to adhere. The market will reward those companies that can develop drugs for chronic diseases and can be administered once every six months to a year.”


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