PM360 asked experts who know how to improve medication adherence about the new challenges that COVID-19 will bring and what other barriers companies should pay particular attention to. More precisely, we asked them:
- How will the COVID-19 pandemic impact patient adherence? How can companies address short-term effects such as an inability to see their doctor, pick up prescriptions, or pay for medication? And what longer term impact on adherence and potential solutions to address it we will see even after more shelter-in-place orders are lifted?
- What barriers to adherence are not being addressed as much as they should? How can pharma better help patients to address these barriers? And what ways can pharma better work with patients to discover these unmet needs?
As access to healthcare declined due to COVID-19, many patients have gotten by with either light therapy or none at all. We will soon see the health and economic impact of this deferred adherence. In the short-term, some manufacturers are adopting more efficient digital channels and tools to get information to patients and providers. Market research overwhelmingly shows that once a patient has a positive digital experience, they don’t want to go back to antiquated models of paper delivery for information. More physicians are adopting e-prescribing technologies and have been extending scripts from 30 to 60 and even 90 days where possible.
Longer-term, we need to be concerned about the potential increase in rehospitalization rates coupled with declining rates of insurance coverage due to the economic fallout. This will have a negative impact on outcomes as a result of lack of access to treatments, particularly essential specialty medications. The value of that category is enormous as it encompasses therapies for the most complex diseases and addresses populations with the highest unmet need. Companies must focus on access to specialty medicine and provide programs to support greater adherence, including financial assistance, therapeutic support messaging for the physician within the EHR, and patient engagement technologies.
A primary contributor to medication non-adherence is high out-of-pocket costs for prescriptions. According to a DrFirst consumer survey, 48% of respondents reported that in the past few years, they have not picked up a prescription due to cost. The study also found that even a $10 rise in copay increases the likelihood of prescription abandonment by as much as 19%. Millions of people have lost their jobs as COVID-19 wreaked havoc on the economy, with unemployment levels peaking at nearly 15% in April. The situation is leading to the very real possibility that more people simply won’t be able to afford their medications.
Patients and HCPs need tools that can provide access to copay assistance programs and additional resources. Shelter-in-place orders are lifting, but many Americans will continue to face economic insecurity for months or even years. Medication costs and adherence will continue to be a public health concern for an indeterminate amount of time. We must embrace solutions that address the key blockers to patients getting on therapy, especially for the more than 130 million Americans with chronic conditions whose lives could be at risk if they fail to take their medications as prescribed.
Patients with rare disease are particularly vulnerable to medication adherence challenges created by the COVID-19 pandemic. Although many rare disease therapy manufacturers have invested in patient support programs (PSPs), these programs may not be designed to provide the support needed during a global pandemic. Quite frequently, PSPs are designed to help patients understand their disease or get started on medication, but do not answer questions like, “How can I be sure I can continue to get my medication?” This is a key question right now. Patients receiving therapies administered in a healthcare setting have even greater risk of missing treatment for myriad reasons such as nursing or supply shortages, fear of getting COVID, or inability to travel.
Some companies are offering virtual self-administration training to patients who are prescribed infused medications, so patients can infuse at home. Additional solutions such as home care, home testing, and telemedicine need to be looked at through a new lens to explore how they might benefit patients with rare diseases. Outreach approaches and communication topics need to be re-evaluated to ensure that they reach and are relevant to patients with rare disease so they feel supported and can effectively maintain their medication routine during the pandemic and beyond.
Currently, we are all experiencing how uncomfortable it is to make decisions in the context of an unknown level of risk. People make active decisions about taking medication every day, and concerns about medication are a well-documented risk factor for non-adherence.
From my experience, pharma is often reluctant to fully acknowledge patients’ concerns about potential side effects due to the risk of eliciting adverse events and a perceived risk of inducing fears. However, patients’ fears already exist; a major source of their concern is information about possible side effects in the patient package inserts (PPI). And, is a report of concern about potential side effects really an adverse event?
We must help patients gain a clearer understanding of risks. It is possible to successfully reduce concerns about potential adverse effects by using psychological behavior-change techniques. For example, using a screener to elicit patient’s issues with medication to guide HCPs’ consultations.
Pharma needs to present risk information within the PPI in a way that patients can understand. Additionally, patient support materials should address concerns using behavior-change techniques. Pharma can also support HCPs with training and materials to have nuanced conversations about risk.
Intentional non-adherence, or those who wish to willfully delude sponsors, can be detrimental to a trial’s success, or lead to improper labeling once approved. Until recently however, the scope of its impact has largely been left unquantified. In partnership with the Tufts Center for the Study of Drug Development, AiCure published a study that leveraged an AI-powered virtual patient monitoring solution to understand intentional non-adherence across 23 clinical trials of psychiatric, neurological, and neuromuscular diseases. The results indicate that 4% of all confirmed doses were intentionally non-adherent, 48% of all study volunteers had at least one intentionally non-adherent dose, and 5% of study volunteers were intentionally non-adherent for more than one-third of all doses required.
Solutions that actively monitor a participant’s adherence behavior and treatment response can help weed out intentionally deceptive behavior and ensure sponsors are not reporting misleading data on the drug’s success. By analyzing behavioral patterns over time, the solution can predict which participants are at risk of not adhering to protocols, allowing sponsors to remove violators from the trial as necessary. These steps can enable a significant bump in drug efficacy and reduce the risk of real-world adverse events.
While many barriers to medication adherence exist today, one less frequently discussed barrier is related to the proper collection and analysis of patient data. In a “Big Data” world, the pharma industry has not yet figured out how to routinely collect and use data for the good of the patient. To address this problem, and increase engagement and adherence, consider building a treatment plan around a patient’s data.
Focusing on their data will allow care teams to focus on the patient. For instance, using smart medical sensor devices can help collect data that can show a care team insights about medication interactions, patient behavior, and more. The ideal scenario, of course, is funneling this sensor data into a hub that also collects patient behavior data, and synthesizing the two for a full 360° view of the patient, and in turn implement new treatment regimens or interventions that can proactively stop negative behaviors and increase adherence. Working with patients using technology they’re already used to (wearables, touchscreens, etc.) can help them feel more connected to their care, thus increasing adherence—as well as provide pharma teams with the insights needed to further engage the patient to improve adherence even more.