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  • 1. Adherence: Is It Worth the Investment? Adherence in a Fragmented World Since the advent of DTC advertising, the pharmaceutical industry has typically prioritized getting people to start taking new prescriptions over other marketing objectives. Although marketers typically consider their marketing program to be effective if new prescriptions increase, the success measures for compliance and adherence are less clear. This paper explores how enhanced patient adherence programs can positively impact patient health and societal well-being, while also increasing pharmaceutical revenue. The Implications of Non-Adherence Low adherence represents $177 billion in lost revenue per year (approximately a quarter of total annual pharmaceutical revenues) and an average per drug loss of 36 percent in potential sales.1 The apparent challenge in securing prescription adherence has significant implications for patients POINT OF VIEW and pharmaceutical companies alike. It is estimated that: • Twenty percent of prescriptions are never filled.2 • Half of all prescriptions fail to have the proper effect because of failure to take the drug or follow instructions.3 • Up to 50 percent of people with chronic ailments are non-compliant.3 • Only one-third of all patients actually take their medications as directed.2 The effects on patient health and revenue from prescriptions are compounded by the fact that most patients and caregivers woefully underestimate their own non-adherence. Only about eight percent of U.S. consumers are aware of their own non-compliance4. Those who are aware of their non- compliance frequently cite reasons that encompass: • Affordability of the medicine • Patient’s belief that medication is not needed • Side effects • Forgetfulness • Lack of information about disease, treatment, or specific medication The societal burden of non-adherence is often overlooked too, with typical non-adherent patients visiting HCPs three additional times per year and having increased treatment costs of $2,000 per year over those following prescribing instructions.5 As many as 10 percent of all hospital admissions and 23 percent of long-term elder care admissions in the United States are a consequence of failed patient adherence.6 Although the ultimate responsibility for adherence lies with the patient or caregiver, given the critical nature of this problem, pharmaceutical companies must decide whether or not they are going to make a commitment to developing and executing adherence strategies as part of their DTC efforts. Progress can only be made if pharmaceutical companies make a concerted and committed effort. © 2009, imc2. All rights reserved.
  • 2. 2 Adherence: Is It Worth the Investment? imc² Point of View POINT OF VIEW Notwithstanding the potential impact that a sound adherence program can have on patient health, prescription revenue, and society, efficiency represents another opportunity. Given that it costs pharmaceutical companies 62 percent more to acquire a new patient than it does to keep an existing one,2 companies should explore strategies to increase adherence among patients. And while studies show that 20 percent of patients will be non-adherent no matter what a HCP or pharmaceutical company does and 20 percent of patients will always dutifully follow their HCPs’ orders, brands imc2 can engage the remaining 60 percent and encourage them to play a more active role in their own well-being.7 Since the benefits of a strong personal network in helping individuals reach goals are fairly well- established, successful adherence programs—the kind that secure and sustain prescribed treatment therapies—should include provisions for establishing and nurturing a strong support network comprised of HCPs, nurses, patients’ families, and caregivers, and employ technologies and channels to reach patients in the most natural and engaging environment. Effective patient education, another vital component of successful adherence programs, must also incorporate a personalized communication strategy within the support system. Ideally patients talk to their HCPs and others in their support system, the HCPs talk to their sales reps, each party gets information via the channel and frequency of their choice, and all messages support the concept of well care and reinforce the benefits of adherence. It moves from the traditional push strategy of most DTC campaigns to a balanced mix of push-pull, with patients having a greater say in the manner and frequency with which they receive and share information. Investing more in adherence programs may allow brands to more nearly reach their full revenue potential, while improving relationships with patients and HCPs. The indirect benefits of a well- designed adherence strategy include decreased societal costs and improved patient health. The return is considerably greater than the modest costs likely necessary to initiate and manage an effective adherence program. What Marketers Need to Consider Going Forward For a variety of reasons, the pharmaceutical industry has historically placed more emphasis on new prescriptions than keeping existing patients on treatment. With the advent of newer technologies, the emergence of the digital channel, and third-party vendors dedicated to keeping patients on their medications, pharmaceutical companies have a unique opportunity to improve adherence and realize the associated health, economic, and societal benefits. Three examples that marketers should consider follow below. Use the Digital Channel to Communicate with Patients The majority of pharmaceutical adherence programs that exist today have a common theme –conformance. There seems to be a “one size fits all” approach to adherence, with little personalization or imagination. The digital channel makes it easier to have a personalized conversation with individuals and enables brands to efficiently communicate with them in their preferred format and frequency. Marketers should identify patient preferences about adherence reminders and use the information to improve both the style and substance of communication. © 2009, imc2. All rights reserved.
  • 3. 3 Adherence: Is It Worth the Investment? Brands can also uncover the factors contributing to non-adherence and develop a stronger relationship with patients to resolve the issues. HCPs also need more effective communication about the POINT OF VIEW importance of discussing ongoing compliance with their patients and educating them on the benefits of adherence. Ultimately this gives patients multiple sources of information and the opportunity to make informed decisions about which sources they prefer and trust. Change the Conversation The digital channel offers pharmaceutical companies the opportunity to effectively change the imc2 conversation—refocusing the dialog from “sick care” to well health care. Patients don’t want to be reminded that they are sick, but they do appreciate messages related to getting well. Ideally, the message should communicate a holistic approach to achieving wellness. Besides staying adherent on the medication, the message can include other information such as diet, exercise, and other lifestyle factors. Materials should convey a message to patients about the benefits of being adherent rather than the risks of not being compliant. Marketers can survey patients about their compliance habits and partner with HCPs to do the same. Therapeutic persistence increases as patients and HCPs become more involved in the conversation. The same practice holds true for connecting at the pharmacy, and although this is increasingly common, there is still a huge opportunity for integrated point-of-care programs that promote relationships between the pharmacy and the patient. Ultimately, this approach drives the patient to seek additional information about their medication. Partner with Existing Adherence Vendors/Technologies Third-party compliance programs such as those offered by Knipper Health Advantage and innovative adherence reminder technologies such as those offered by Vitality are currently underused. Knipper Health Advantage is a comprehensive point-of-care program offering lifestyle coupons, recipes, and offers to use with a patient’s prescription. It reinforces the message of “well care” and takes into account the holistic wellness philosophy. Knipper partners with many of the largest consumer goods and health-related companies to offer this program. Vitality is a company that has recently launched Glow Cap Connect, a wireless prescription bottle that glows and plays a tune to remind patients when it’s time to take their medicine. It also keeps track of a patient’s daily doses by counting the times the cap is opened and sending the data to a Vitality-hosted database. Summary Effective adherence strategies can be devised to address patients’ reasons for not following their prescribed treatment therapy. But whatever the strategy, sound program implementation must at least consider the role of each member in the treatment continuum—the brand team; medical professionals; patients, caregivers and influencers; and managed care and retail partners. And brands need to establish proficiency at engaging each of these stakeholders in meaningful dialogue. To achieve this goal, communication must be relevant, timely, and personalized—all criteria that can be met with the right combination of audience insight, effective brand- and consumer-specific program planning, efficient digitally enabled communications, and some fairly traditional and familiar resources. Patient adherence may well be the spark that lights three fires: increased pharmaceutical profitability, expanded societal benefit, and improved patient health—all of which merit consideration on their own, but that collectively present a compelling and rational case for investment. © 2009, imc2. All rights reserved.
  • 4. 4 Adherence: Is It Worth the Investment? Works Cited POINT OF VIEW 1 IMS Special Pharma Strategy Supplement: Reviving the Primary Care Market, (July 17, 2008) IMS Health. 2 Pharmaceutical Patient Adherence and Disease Management: Program Development, Management and Improvement, (2006) Cutting Edge Information. imc2 3 Koroneos, George, (August 1, 2008) Hard of (Ad)hering, Pharmaceutical Executive. 4 Boehm, Elizabeth W., Brown, Eric G. and McEnroe, Will, (April 14, 2006) Rx Adherence Hits The Ignorance Wall, Why Pharma And Payers Must Put More Muscle Behind Drug Compliance, Forrester Research. 5 Medication Compliance-Adherence-Persistence Digest, (2003) American Pharmacists Association. 6 Roner, Lisa, (July 10, 2008) The Real Cost of Patient Non-Adherence, Eye for Pharma. 7 Wulf, Stanley, (October 3, 2008) Take Your Medicine: A Prescription for Brand Growth, Pharmaceutical Executive. dallas new York city Philadelphia 12404 Park Central Drive, Suite 400 622 Third Avenue, 11th Floor 1100 E. Hector Street, Suite 100 Dallas, Texas 75251 New York, New York 10017 Conshohocken, Philadelphia 19428 214.224.1000 212.430.3200 610.729.1310 © 2009, imc2. All rights reserved.
  • 5. APPendIx: exAmPles Best-In-Class Adherence Examples POINT OF VIEW Following are several pharmaceutical adherence program examples that highlight how brands can take several different approaches to tackle the same fundamental issue. Knowing that all diseases are unique, and that medications and treatment regimens vary greatly, a program should address the specific needs of the audience, while accommodating distinct condition and therapeutic realities. imc2 EMD Serono—Cool Learnings Cool Learnings (coolclick.com), a program that leveraged multimedia educational materials and youth-oriented content to teach kids the proper use of EMD Serono’s Saizen—a recombinant growth hormone—rewarded patients with MP3 music downloads for correctly answering quizzes related to the prescription and treatment. This helped break the primary barrier to compliance—which was that the children simply weren't aware of how to manage their condition. EMD Serono used its sales force to This innovative, incentive-based-based adherence program This innovative, ince n tive adherence program targeting youth was a COPPA-complaint COPPA targeting youth was a education -co mplaint education microsite, initiative. Housed on a ini tiative. effectively communicate this program to HCPs. the program increasedoadherenceprogram this creased adherence Housed on a micr site, the among in audience and improved lifetime patientaudience among this value. and i mproved lifetime patient value. AstraZeneca—Measures of Success The Measures of Success program encourages patients to register online and access a trio of disease management tools, including reminder messages and patient testimonials. A major component of this program allows patients to log in or telephone each day to let AstraZeneca know they have taken their drug at the prescribed time. During this call, patients hear a short message reinforcing the importance of staying adherent, and for doing so, patients are rewarded with points that can be exchanged for medically relevant products. GlaxoSmithKline—alli Although not an RX product, compliance is still a key component of the alli program (myalli. com), which incorporates a rich, personalized behavior support program. The program is tailored to deliver the level of support that is best for the individual to reach his/her goals. It provides participants access to nutritional support, meal planning tools, weight tracking tools, exercise and behavior modification information, the vast online alli community, and personalized feedback. alli continuously evaluates adherence and evolves programming to build all contin u ously evaluates adherence and evolves more effective and sustainable treatment options for consumers. GSK’s programming to build more effective and sustainable team and imc² built a s for cons u mers. GSK’s team and imc treatment optio n program that is personal, customized, dynamic, and really effectivethat is personal, cusers u st o mized,who can help built a program at connecting alli with others dynamic, support them effectiv weight loss and wellness goals. w ith others and really in their e at connecting all users who c an help support them in their weight lo ss and wellness goals. © 2009, imc2. All rights reserved.