As is often the case, it’s not a single driver that shapes a trend but rather a confluence of many. this month we examine the factors that affect compliance with a special look at the human growth hormone market.
Most marketers spend a significant portion of their budget addressing patient adherence—hoping to get as many incremental prescriptions as possible out of their current patients. Adherence is of course important—it can save lives and reduce costly medical events and hospital stays. But are pharma marketers really focusing their precious budget dollars in the right way?
For years brand marketers and market researchers have monitored patient persistence, compliance, length of therapy and other loyalty metrics. We tend to think of these as a “report card” of brand usage among patients. Today, we can use data to understand what levers may be available to best address factors such as which populations are more or less adherent. This often generates reams of charts and graphs, which can be time consuming, difficult to work with and still not tell us the whole story.
So what about more nuanced insight into what’s driving these factors? We need to get smarter about how we answer our business questions and to focus on data that is most actionable and that can help drive our brand forward. There are statistical techniques that allow us to examine the impact of any number of patient, prescriber and payer attributes to quickly identify those areas that are most at risk to poor adherence—or those segments where we have the most success. Too often though, these techniques are not utilized, which leaves us with only part of the story—the report card—or worse, analysis paralysis.
Marketers are looking for better insight that can provide direction for addressing the problem so that the dollars allocated to address adherence can be used more effectively. In past “Market Drill-Down” columns, we have talked about using data to target co-pay assistance where and when it is needed, rather than using a “blanket approach”—and adherence is no different.
For example, recent data on the human growth hormone market demonstrates what can be done. The data show that persistency—in terms of number of days on therapy—varies by product; however, most exhibit a similar patient drop-off curve. But when we look beneath this curve and analyze patient and prescriber attributes, we see the following drivers:
Age Matters: Patients who are under the age of 25 are significantly more likely to have a longer length of therapy.
Prescriber Specialty Matters: Those patients who were initiated on therapy by a specialist had a longer length of therapy than did those initiated by a PCP or other specialties; within a specialist community, those initiated by a pediatric specialist had a longer length of therapy than did those initiated by a non-pediatrics specialty.
Factors Affecting Compliance
Similarly, when we look at data for a chronic adult market (Figure 1), we find that age also matters—adults in the middle-age and lower-age groups are more likely than their older counterparts to be compliant with their medications. For this brand, this is of particular concern because the majority of patients are in the age group of 65-plus.
Further, we find that lowest cost is not always the answer. As Figure 2 shows, patients with commercial insurance are 30 percent more likely to be compliant (than cash-payers), but only when they have a moderate level of out-of-pocket exposure. When we look at co-pay data (Figure 3), we see that having some out-of-pocket exposure is more predictive of the desired patient behavior of compliance than when patients have $0 or more than $30. This data suggests that, at least for this brand, having some “skin in the game” is crucial to maintaining compliant behavior.