Medication non-adherence has long been recognized as the elephant in the corner of the room when it comes to the silent weight on the healthcare system. The actual impact, while difficult to measure, is believed to have anywhere from a $150 to $300 billion impact. The rationale for the impact is intuitive, patients who don’t take all of their prescription medication are less likely to recover, and have a greater propensity to need a repeat prescription and/or possibly more expensive treatment.
While the burden on the healthcare system is great, so is the revenue loss to the pharmaceutical manufacturer. The reality is that when patients take their medication as prescribed, both patients and the pharmaceutical manufacturers benefit; patients through greater efficacy and manufacturers through a greater number of pills sold. Additionally, as healthcare payment systems increasingly emphasize (and reward) outcomes, all members influencing patient Rx compliance will need to work together to develop creative and effective approaches to engage the patient in personal health management communications that resonate.
Given the impact, the pursuit of greater levels of patient adherence is in the best interests of both the commercial and clinical sides of the health care industry. The purpose of this post is to put forth some of the definitions and elements worthy of consideration, while providing a brand marketer with options to consider as they look to increase levels of adherence.
Most of us are familiar with retail, credit card and hospitality loyalty programs. Consider even utility and telecommunication companies – to the extent consumers have a choice in their provider –who are seeking out ways to build loyalty with customers, through service bundling and recurring billing.
Pharma brands, on the other hand, have primarily focused on acquisition, with the expectation that the health care professional (HCP) would manage treatment adherence with their patients. For many years, this was sufficient to ensure healthy returns for shareholders. Interestingly, many brands didn’t even begin to tackle adherence until late in the product lifecycle. To the extent that brands did address adherence, the task was relegated to the marketing department, which disseminated educational material and refill reminders to a small population of hand-raisers (CRM opt-ins), who weren’t necessarily the patients most in need of support.
In recent years, these efforts have been augmented with financial incentives (copay reductions, rewards, etc.), nurse / pharmacist counseling programs, as well as outcome based payment agreements, to cite just a few of the many adherence initiatives that are being piloted. While these developments are a healthy sign that pharma brands are recognizing the impact of non-adherence on both patient health and the bottom line, the reality is that their efforts have collectively failed to move the needle, despite the fact that individual initiatives may have been proven effective.
In large part, this lack of impact is due to a failure to understand the drivers of non-adherence; develop meaningful and effective solutions that are matched to the appropriate patient segments; and integrate the initiatives across the organization.
Changing the Paradigm
The multi-faceted nature of patient adherence demands a multi-faceted approach that synchronizes the efforts that ensure a prescription is written, filled, and used (as intended) to bring about positive patient outcomes. Consider the journey:
- The HCP needs to be made aware of the product and its indications relative to their patient base
- The patient needs to recognize their situation and the fact that the Rx in question has clinical value relative to their situation
- The HCP’s office staff needs to be well versed in formulary status, co-pay opportunities, patient communication and information tools
- The pharmacist needs to recognize (and possibly be compensated for) effective patient: drug utilization communications
- Actuarial analysis within the Payor/Managed Care Organization (MCO) needs to recognize the long term cost benefit associated with adherence and facilitate positive treatment outcomes
- The health institution needs to recognize and be rewarded for proper communications and patient education
The good news is that more and more stakeholders are stepping up their efforts, motivated in no small part by the financial pressures on the industry, as well as the Affordable Care Act, which places new emphasis on treatment outcomes and patient experience. Fundamentally, however, brands must shift their mindset from encouraging adherence to their particular therapy to supporting the individual holistically. The reality is that most patients suffering from chronic conditions such as diabetes, depression, and HIV require multiple prescription medicines, and confront a range of issues in managing their health.
The foundation for change must also be anchored in the reality that, although consumers are accessing health information online, physicians and other healthcare professionals “continue to be the first choice for most people with health concerns.” (The Social Life of Health Information, 2011, Pew Research.) Thus, it is critical that pharma brands develop and execute communications that foster a collaborative partnership between patients and HCPs, rather than simply facilitating a transaction that produces a script for a particular medication and leaves the patient or caregiver with the primary responsibility for overcoming barriers to adherence. In essence, the nature and substance of the patient-physician dialogue needs to change.