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$100Bn Public Health Problem–Poor Medication Adherence– David Parpart's Research

The document emphasizes the importance of improving medication adherence, citing its potential to significantly enhance population health and reduce healthcare costs, with an estimated annual financial impact of poor adherence reaching over $500 billion. It highlights serious consequences of non-adherence, including high rates of hospital readmissions and unnecessary deaths. The proposed solutions include utilizing technology like electronic monitoring and pharmacist-led counseling to encourage patient adherence and lower overall healthcare expenses.

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“Increasing the effectiveness of adherence interventions will have a far greater impact on the health of the population than any improvement in specific medical treatments.” World Health Organization Confidential - Socially Relevant Inc. IMPACTMeds
Meaningful Use of Health Information in US Confidential- Socially Relevant Inc.
t SOURCE: IMS
Projected Growth to $350-380Bn in 2016 73% ($) from Branded Sales $226Bn in Chronic Sales $227Bn in Retail Sales $188Bn in Losses Due to Poor Adherence Potential Market $508Bn $320Bn in US Rx Sales Confidential - Socially Relevant Inc.
65,000 outlets 25 Companies own 50%, 40% independent $227Bn in Rx Sales 95% of American Live within 5 miles 95% of American enter monthly Pharmacists are trained in medication adherence Retail Pharmacies Confidential - Socially Relevant Inc.
• 2 in 3 US Hospitals Fined for excess readmission (10/12) • Fines and standards will increase thru 2015 • Pre-admission medication list accuracy only 16% • 1 in 5 Medicare patients readmitted within 30 days with adverse drug events • Poor adherence Rated #1 cause of readmissions – Costing US insurers $100Bn+ in unnecessary hospital visits • 29% of Americans take 5 or more medications
67% of People Who Need Medications Will Stop Buying Them Within 24 Month Confidential Do Not Distribute
POOR ADHERENCE • Fewer Drugs Sold • Poor Outcomes • Higher Costs • Hospital Admissions • Unnecessary Deaths 0 10 20 30 40 50 60 70 80 90 100 0 1 2 3 4 5 6 7 8 9 10 11 % Persisting Months on Lipid Lowering Medication
Patients often suffer from unnecessary complications including heart attacks, strokes, heart failure, peripheral vascular disease, amputations. End-stage renal disease, retinopathy and vision loss.
P O O R A D H E R E N C E M O N E Y & D E AT H T H E U N S A V O R Y N U M B E R S Confidential Do Not Distribute
Confidential Do Not Distribute $350 billion in productivity losses $290 billion in additional hospital costs $188 billion in lost drug sales $100 billion in avoidable hospital visits 350 preventable deaths per day
1,000,000 Unnecessary Deaths can be Prevented this Decade with Improved Medication Adherence TogetherwecanmakeaBIG IMPACT!
Adherence is a rampant problem even among people undergoing Treatment for Dialysis, Transplants and Cancer
SOURCE: Understanding and Improving Adherence for Specialty Products, IMS Chain Stores Food Stores Independent Mail Service
0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of Prescription Consumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer Increase Prescription Sales by 59% with Improved Adherence 188 BILLION DOLLARS
Increased Adherence = Incremental Sales # of Prescriptions Filled 0 100000000 200000000 300000000 400000000 500000000 600000000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Sales ($) Months Comparative Product Sales Existing System Income Additional Income (IMPACTMeds) = $3,134,339,366 Confidential Do Not Distribute
Improving medication adherence by only 25% across 65,000 retail pharmacies will increase sales by 33 BILLION DOLLARS
What’s Missing? Social Factors Economic Factors Health System Factors Patient-Related Factors Condition Therapy
What can you do to stop this growing crisis for healthcare stakeholders and the rising costs of poor adherence?
“Medication Adherence is a $100Bn business opportunity” New England Health Institute, 2012 “…electronic monitoring devices, and pharmacist-led counseling are among the least costly intervention.” Roebucks M et al, Health Affairs, 2010 Confidential Do Not Distribute
$180/mo. $3,172* ave. 24 mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. Interactive Marketing Channel Labels *Assuming persistence increases sales by only 50% Confidential Do Not Distribute
Improving adherence for Lipitor, Norvasc, Lyrica and Celebrex alone Would Increase sales by $6.5 billion dollars
Estimated Annual Value $1000-1999M $2,000-4,999M $5,000M+ $100-499M $500-999M Assuming 20% of customers utilize pharmacist services and persistence increases sales by only 50%
Estimated Annual Value $100-999M $1,000-1,999M $2,000M+ $396,000 $50-99M 28,000 Independently Owned Pharmacies Assuming 66 new customers per/mo./pharmacy utilize services and persistence increases sales by only 50% for one brand name medication
Health Care Cost-Savings from Adherence
Improving medication adherence in the US is capable of reducing national health spending by 5.5% (0.98% of GDP) SOURCE: IMS 2012
350 BILLION DOLLARS in productivity losses for US employers is due to poor medication adherence for only five conditions SOURCE: Booz & Company 2012
The Gold Standard Solution 14 years of clinical trials conducted by the American Pharmacy Association demonstrate an increase in drug sales by 2x and adherence by 3x Project IMPACT
0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of Prescription Consumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer 12 15 18 21 24 0 5 10 15 20 25 Current Model 25% 50% 75% IMPACT Trials 24 mo. Sales (#) Adherence Increase IMPACT Clinical Trials Increase Prescription Sales by 104%
0 10 20 30 40 50 60 70 80 90 100 0 1 2 3 4 5 6 7 8 9 10 11 % Persisting Months on Medication • 2x Sales Increase • 90-93% Persistence at 24 months • High Patient Satisfaction Pharmacists-LedCounseling
Leading the Industry in Pharmacy Research and Expanding the Role of Pharmacists in Health Care
Prize Winner of the Sanofi US Innovation Challenge Specializing in Medication Adherence
Confidential- Socially Relevant Inc.
E A S Y T R A C K I N G A T H O M E • “Caring” Reminders • Track Administration • Positive, Side Effects and Adverse Events • Self-Monitoring of Biometrics • Food Consumption Confidential- Socially Relevant Inc.
T O O L S F O R C A R E G I V E R S Confidential- Socially Relevant Inc.
I N T E R A C T I V E L A B E L S F O R S M A R T P H O N E S • Convenient Way to: • Track Medication Administration • Track Biometrics • Purchase Refills For Marketers NFC vs. QR • 12x higher Tap rate • 5-10x time on site (48 sec vs. 5-10 sec) • 36% tap to action rate Confidential- Socially Relevant Inc.
$71Bn in Out-of-Pocket Expenses
Prepaid MedCredits Name: Patient No: Signature: ACO _________________________ Manufacturer _________________________ Insurance _________________________ John Doe A987654 Employer _________________________ Date: 04/30/13 100 200 400 QTY MedCredits Get answers to medication questions for free and receive special care. Redeem Med Credits at your local pharmacy or www.IMPACTMeds.com Med Credits expire in 60 days. Ask your pharmacist for more. Special Care Provided by: ™ ™ The Users’ Experience Medicare Part D Dallas Nephrology
HOSPITALIZATION RISK HOSPITALIZATION RISK HOSPITALIZATION RISK Useful Analytics Confidential Do Not Distribute
Predictive Algorithms and Indexes Analytics and Predictive Algorithms Readmission Risk Index Uses EHR Data to Predicts Readmission Risk & Future Days in Hospital Non-Adherence Risk Index Predicts Medication Non-Adherence Flags Patient on Providers’ Case Manager Screen Stimulate Early Personalized Intervention Confidential- Socially Relevant Inc.
We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence Confidential - Socially Relevant Inc. IMPACTMeds
The World’s Largest Medication Adherence Program Launching Spring 2013 Opportunities Available • Strategic Partnerships & Alliances • Program Sponsorship Join us now and play a leading role! IMPACTMeds
Contact information: BenjaminBluml,R.Ph. VP Research APhA Foundation www.APhAFoundation.org 2215 Constitution Ave. NW Washington, DC 20037 202-429-7571 bbluml@aphanet.org DavidParpart,D.C. CEO iRetainRx www.iRetainRx.com 440 N Wolfe Rd. Sunnyvale, CA 94085 408-329-9344 Ext:1001 drparpart@sociallyrelevant.com IMPACTMeds Confidential - Socially Relevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence
Easy-to-use mobile apps and NFC labels for interactive medication reminders, education and tracking usage MOBILE ENGAGEMENT
MedCredits iRetainRx Specializes in Retention Marketing for Medications. Med Credits provide Manufacturers & Retailers with a Simple Mechanism to Invest in Retaining High Value Customers
MedCredits 1.) Manufacturers & Retailers Select High-Value Customers and Provide Their Customers with Med Credits. 2.) Customers use Med Credits Virtual Currency to Purchase Services and Tools that Improve Medication Adherence and Sales, such as Pharmacist Counseling, NFC Sticker, Glow Caps etc.
The Users’ Experience The Clinic/Pharmacy personal device report in stantly ac c essib le to d oc tors an d p h armac ists At Home u se mob ile or computer to upload, share and view p erson al p rofile d ata Confidential Do Not Distribute
Co-operative Marketing IMPACTMeds enables stakeholders to dramatically increase medication adherence, something they have been unable to scale despite $188Bn in Losses
Co-operative Marketing IMPACTMeds enables stakeholders to dramatically increase medication adherence and customer lifetime value (LTV), something they have been unable to scale despite $188Bn in Losses
$180/mo. $3,172* ave. 24 mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. *Assuming persistence increases sales by only 50% Pfizer Pharmacy Months to Discontinue Current Lipitor Sales $2,106 2,106 12 Sales with IMPACTMeds $3,172 $3,172 18 Increased Sales $1,066 $1,066 6 Pfizer Pharmacy Patient APhA and iRetainRx IMPACTMeds Marketing Distribution ($550) $275 $180 $95 Co-operative Marketing EXAMPLE 1
$180/mo. $4,120* ave. 24 mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. *Project IMPACT Hyperlipidemia persistence rate Pfizer Pharmacy Months to Discontinue Current Lipitor Sales $2,106 2,106 12 Sales with IMPACTMeds $4,120 $4,120 23 Increased Sales $2,034 $2,034 11 Pfizer Pharmacy Patient APhA and iRetainRx IMPACTMeds Marketing Distribution ($860) $500 $230 $130 Co-operative Marketing EXAMPLE 2
Poor Adherence Costs $188Bn Lost Lost $’s / Penaltie s $290Bn Costs $125Bn Lost $188B n Lost Pharmacists /Manufacturers $188Bn Lost Sales Insurers/Employers $290Bn in add’l Costs $100Bn Unnecessary Hospital Visits Employers $125Bn in Productivity Losses Doctor and Hospitals Less ACO/PCMH Revenues Readmissions Penalties Consumers Strokes, Heart Attacks, Suicide, Amputations etc.
Patients often suffer from unnecessary complications including heart attacks, strokes, heart failure, peripheral vascular disease, amputations. End-stage renal disease, retinopathy and vision loss.
Confidential- Socially Relevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence IMPACTMeds Incentive Slide for Employers/Insurers and the Government
Improving medication adherence by only 25% just for Lipid Lowering Drugs would increase Pharmaceutical sales by 3.6 BILLION DOLLARS SOURCE: Comparing Adherence & Persistence, J Managed Care Pharm and 2011 industry data from IMS
Improving medication adherence by only 25% just for Diabetes Drugs would increase Pharmaceutical sales by 2.9 BILLION DOLLARS SOURCE: Estimated Annual Pharmaceutical Revenue Loss Due to Medication Adherence, Capgemini Consulting
127 BILLION DOLLARS in productivity losses for UK and German employers is due to poor medication adherence for only five conditions SOURCE: Booz & Company 2012
SOURCE: Booz & Company Improved medication adherence is capable of producing € 20Bn to € 43Bn in productivity gains for employer in the UK, Germany and the Netherlands
Confidential- Socially Relevant Inc. Participating Pharmacies Delivering IMPACT Persistence: 90-93%
• IMPROVED PATIENT HEALTH • INCREASED PROFITS • NEW REVENUE STREAMS • INCREASED PATIENT ENGAGEMENT, LOYALTY & STICKINESS • IMPROVED EFFICIENCY • TECHNOLOGY SOLUTIONS • DRUG MANUFACTURERS • PHARMACIES • ACOs & PCMHs • HOSPITALS • SPECIALITY MEDICAL GROUPS • HEALTH IT & MOBILE DEVELOPERS WHO WE SUPPORT WHAT WE PROVIDE OUTCOMES DELIVERED • MULTI-SYSTEM INTEGRATION • CROSS-PLATFORM DELIVERY • ADHERENCE EXPERTISE • EASY TO IMPLEMENT ADHERENCE TOOLS & TECHNOLOGY • PATIENT-CENTERED OUTREACH & SUPPORT • PATIENT EDUCATION • ADHERENCE RESEARCH & RISK ANALYSIS Confidential- Socially Relevant Inc. IMPACTMeds
Gives Prescription (Rx) to Pharmacy Employee Fills Out Patient Profile Adherence Risk Assessment Arrive at Pharmacy Greets Customer (RPh/Tech) Personalized Receives & Checks Rx (RPh/Tech) Computer Entry (Tech) Fill Rx (Tech) Ok’d byRPh Pharmacy Exterior Parking Appearance of Non-pharmacy Departments Employee Dress Non-prescription Merchandising Waiting Area Patient Information Brochures Signs Line of Interaction Line of Internal Interaction Line of Visibility Clarification Needed? Yes No Calls MD’s Office(RPh) Drug Interaction or DUR Notification? Do not fill Insurance DUR Notification Check Rx (RPh) Clarification or Change Made with Rx Profile Reviewed (RPh) Picks Up & Pays for Rx Is Counseled About Rx Tablet Visual Aids Appearance of Rx Labels Appearance of Drug Bill Drug Information Insert Mobile Application Medication Wallet Card Presents Bill for Rx and Merchandise (RPh/Tech) Counsels Patient (RPh) MTM Dashboard for Targeted Interventions Service Blueprint for Dispensing Services
M E D I C AT I O N D O C U M E N TAT I O N E X C H A N G E The Basis For Scalable Medication Adherence Confidential- Socially Relevant Inc. 66 Community Pharmacies General Practitioners Dispense and Prescription Queries E-Prescriptions Dispense References Care Information Broker (Act Registry) PRESC GP1 PAT1 PRESC GP1 PAT2 PRESC HOSP1 PAT1 … DISP PHARM1 PAT1 DISP PHARM2 PAT2 … ADVICE PHARM1 PAT1 ADVICE PHARM1 PAT1 Med Administration Self-Monitoring Patient Generated Advice, Education & Counseling (MTM) PHARM Laboratory Hospital Dependance Pharmacy GP GP GP centre Hospital
67 Prescription Dispense Use/administration X Advice, education & counseling
Architecture
Architecture Patient Self- Management Credentialing Caregivers Connect MTM App with RooBroo
0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of Prescription Consumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer Current Model 25% 50% 75% IMPACT Trials Sales 11.6 14.6 17.6 20.6 23.6 0.0 5.0 10.0 15.0 20.0 25.0 24 mo. Sales (#) Effect of Increased Adherence on Life Time Value IMPACT Clinical Trials Increase Prescription Sales by 104% Adherence Increase
• Administer Patient Assistance Programs • Risk Evaluation Mitigation • Corporate Social Responsibility– Track Impact and ROI More Opportunities For Manufacturers
Data: Adherence and Persistence What data do we want to capture? At Pharmacy: Patients’ adherence knowledge, skills and performance Pharmacists interventions and medication documentation Claims and persistence At Home: • Medication administration • Self Monitoring- Glucose, BMI, A1C, BP • Meds Dose/response relationship • Diet • Exercise • Positive, Side Effects and Adverse Events • Anthropometric How do interventions affect adherence and persistence? How does adherence in one intervention relate to other interventions? Anatomized Data Provided for Safety Analysis
Imp rove Pat ie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt IMPACTMeds
Imp rove Pat ie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt Adherence Solutions •Safety; Side effects; Efficacy •Self-Care Patient Education •Mobile •Telephone IVR Reminders •Synchronize Refills •Frequency Simplify Dosing Regimen •Payment Assistance Programs •Rewards programs Costs •Blister Packs Specialty Packaging •Laboratory Tests •Self-Care Disease Management •Doctors •Family Caregivers Coordination of Care
0 50000000 100000000 150000000 200000000 250000000 300000000 350000000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Income ($) Time (in months) Comparative Product Income Existing System Income Additional Income (Project ImPACT: 2012) = $1,399,356,000 Additional Annual Sales in Texas and California Alone Increased Retention– Manufacturer Profits
FAMILY CAREGIVERS DRUG MANUFACTURERS PHARMACIST PHYSICIAN PATIENT IMPACTMEDS Supports the Adherence Team
Getting and annual flu shot Avoid overeating Getting enough exercise Getting enough sleep Eating a healthy diet Avoid smoking Taking medication as prescribed Most Important Health Behavior , All Respondents 4 0 , 0 0 0 R a n d o m l y S e l e c t e d A m e r i c a n s 1 8 o r O l d e r C u r r e n t l y Ta k i n g M e d i c a t i o n U s e d t o T r e a t a t L e a s t O n e C h r o n i c C o n d i t i o n When survey participants ranked the importance of several health behaviors MEDICATION ADHERENCE WAS VALUED AS THE MOST IMPORTANT!
Retention Risk Index Doctor Visits Pharmacy Refills Help People Take Medication Correctly
CAREGIVER & FAMILY MANUFACTURERS PHARMACIST PHYSICIAN PATIENT PAT I E N T - C E N T E R E D C A R E
P h a r m a c i s t s E n g a g e P a t i e n t s a n d C a r e g i v e r s i n A d h e r e n c e A s s e s s m e n t , C o u n s e l i n g a n d E d u c a t i o n Grandpa’s Story
While many interventions (e.g. education in self-management (25-34); pharmacy management programmes (35,36); nurse, pharmacist and other non-medical health professional intervention protocols (37-43); counselling (44,45); behavioural interventions (46,47); follow-up (48,49) and reminders, among others), have been shown to be effective in significantly improving adherence rates (50-54), they have tended to be used alone. A single- factor approach might be expected to have limited effectiveness, if the factors determining adherence interact and potentiate each other's influence as they are likely to do. The most effective approaches have been shown to be multi-level - targeting more than one factor with more than one intervention. Several programmes have demonstrated good results using multilevel team approaches (55-57). Examples include the Multiple Risk Factor Intervention Trial Research Group, 1982 (58) and the Hypertension Detection and Follow-up Program Cooperative Group, 1979 (59). In fact, adequate evidence exists to support the use of innovative, modified health care system teams rather than traditional, independent physician practice and minimally structured systems (60,61). Various interventions are already being implemented by many different health care actors. Although not all of these actors are directly responsible for providing health care, they nevertheless have an important role in improving adherence because they can influence one or more of the factors that determine adherence. The work that is being done to improve adherence and the persons performing the work are described below. Excerpt from World Health Comprehensive/Personal Approach. No one-size fits all.
Confidential- Socially Relevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence IMPACTMeds
Confidential- Socially Relevant Inc. Why Does IMPACT Improve Medication Adherence? Patients Explain, “I Feel My Pharmacist Cares” IMPACTMeds It’s NOT a Tough Egg to Crack Internal Forces Applied to Break an Egg Generates New Life
Confidential- Socially Relevant Inc. People Persist on Medications they BELIEVE are Important from Pharmacists that CARE IMPACTMeds It’s NOT a Tough Egg to Crack Internal Forces Applied to Break an Egg Generates New Life
IMPACTMeds Confidential - Socially Relevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence
Clinical Lab IMPACTMeds
InfoMeters
iRetainRx Now Distribution of Brand Information F DA & B ra n d e d P r i n t a t P o i n t - o f - C a re We b s i t e s At H o m e A p p s F DA & B ra n d e d P o i n t - o f - C a r e O n - t h e - G o Confidential Do Not Distribute
Benefits to Sponsors • First Look/Priority Access to Stats and Data • PR/Marketing Brand Awareness • Premium Networking Opportunities • Brand Visibility • Advertising and Educational Marketing to Providers Doctors and Pharmacists • Co-Branding of Consumer Hardware NFC Labels and NFC Smart Stickers Personal Medication Record Wallet Card
• Increase Adherence & Sales • Increase Brand Awareness • Increase Brand Loyalty • Extend Brand Name Product Life • Competitive Advantage & Differentiation • Improved Patient Outcomes • Increased Prescription Rate • Personal Channel • Opt-in Education Marketing Channel • Integrated Education & Purchasing • Access to New Innovative Value Layer for Adherence Stakeholders Benefits For Manufacturers
• Monthly Rx Cost >$80 • Losses From – Rapidly Declining Persistence – Missed Doses – Generic Competition – Class Competition • Medium to High Margins • Customer Retention Marketing Budget Benefiting Products
Premium Networking Opportunity For Medication Adherence Stakeholders • Pharmacies • Pharmaceutical Manufacturers • Medical Groups, PCMH & ACOs • Specialty Medical Groups • Employers/Insurers • Governments • Pharmaceutical Distributers • State and Nation Associations • Payments and Credit Cards • Information Technology • Telecommunications IMPACTMedsCONFERENCES
  Part 1 of 5 – PSPC Overview Website: http://www.hrsa.gov/publichealth/clinical/patientsafety/index.html
 US Department of Health and Human Services  Health Resources and Services Administration (HRSA) o Improving access to health care services for people who are uninsured, isolated or medically vulnerable. o Healthcare Systems Bureau - Office of Pharmacy Affairs provides leadership and oversees the 340B program as well as PSPC 98 PSPC Overview
 More than 133 million Americans live with chronic illnesses1  91% of all prescriptions filled for a chronic condition2  1.5 million people are injured each year as a result of medication3  Uncoordinated care costs an estimated $240Billion/year 4 99 1. CDC National Center for Chronic Disease Prevention and Health Promotion: Chronic Disease Prevention http://www.cdc.gov/nccdphp/overview.htm 2. American Heart Association. Heart Disease and Stroke Statistics–2008 Update. Dallas, Texas: American Heart Association; 2008.http://www.americanheart.org 3. Institute of Medicine (IOM), To Err Is Human: Building a Safer Health System, Washington, DC: National Academy Press; 2000 4. Owens, MK “The Health Care imperative: Lowering Costs and Improving Outcomes”, The Institute of Medicine, 2010 PSPC Overview
WHAT: Quality Improvement Collaborative aimed at improving health outcomes and patient safety for high- risk patients (Adapted IHI Breakthrough Series Collaborative Model) Improve the delivery system where there are gaps by: o Enhancing care coordination among the providers and partners involved o Fostering multidisciplinary, team based care approach o Strengthening patient centered medical home o Integrating medication management and other services to minimize harm related to adverse drug events and maximize optimal health outcomes 100 PSPC Overview
PSPC 5.0 AIM: Inter-professional teams that improve the health outcomes and safety for high medication risk populations through patient-centered, cost-effective medication management services aligned with quality national standards. PSPC’s vision: To engage 3,000 communities in the US who will have integrated care teams that will ensure optimal health outcomes and safety for every patient. 101 PSPC Overview
The transformational goal of the PSPC:  Integrate the healthcare delivery system, across multiple healthcare partners, to create a service delivery system for high-risk patients that will produce breakthroughs in the following three areas: o 1) Improved patient health outcomes o 2) Improved patient safety o 3) Increase utilization of cost-effective and integrated medication management services 102 PSPC Overview
WHO: Community based teams across the country o Organizations include safety net provider and hospitals, public health departments, and HIV clinics o Partners include colleges of pharmacy, primary care associations, and Quality Improvement Organizations o Multidisciplinary care teams delivering patient centered services to improve medication safety and health outcomes This is about saving patient lives! 103 In our 4th year (2011-2012), we had over 200+ community based teams from 48 states + DC, PR and VI participate! PSPC Overview
 In our 3rd year (2010-2011)* some of the accomplishments include: o The 39 Teams tracking improvement for the Diabetes PoF reported an average improvement in the health status marker of 35% o The 12 Teams tracking improvement for the Hypertension PoF reported an average improvement in the health status marker of 40% o Teams also reported a decrease in the average number adverse drug events (ADE) from 0.7 to 0.5 ADEs per patient. o The average number of potential errors per patient decreased from 1.5 per patient encounter at start up to 0.8. o In 2011, APhA Foundation honored PSPC with the Pinnacle Award for being able to demonstrate approaches that assist patients and their caregivers in achieving better outcomes from their medications *4th year accomplishments still being compiled 104 PSPC Overview
 Patient-Centered  Interdisciplinary Care Team  Cross-Organizational with Health Homes at the Center  Systematically Addresses Medication Management, Safety and Risk -- Huge Issues for Ambulatory Care Patients  All Teach, All Learn  Align with national efforts (ex: Partnership for Patients) It Is Truly the Next Generation of Collaboratives! 105 PSPC Overview
OTC and Nutraceuticals
Consider the impact of this non-compliance on both the manufacturer of Plavix and the healthcare system as a whole. Bristol-Myers Squibb reported $2B in sales of Plavix in 2010. With an 83% compliance rate within the first four months of therapy, THERE COULD BE $400MM OF LOST REVENUE EVERY FOUR MONTHS. THIS TRANSLATES INTO$1.2B ANNUALLY IN LOST REVENUE DUE TO NON-ADHERENCE. Prior to the patent expiration of Plavix, there were an estimated 4MM patients on Plavix. In addition to these patients, there are an additional 3MM patients on Coumadin and other anti- platelets. If there is a similar non-adherence rate for Coumadin and other anti-platelets, the TOTAL ANNUAL REVENUE LOST FOR THE PHARMACEUTICAL INDUSTRY IS OVER $2B. Adherence is hindered by two factors 1.) the lack of disease and therapy specific information and tools for adherence and 2) the limited ability for the pharmaceutical industry to have interaction with the patients. “We are seeing a sizable portion of patients drop off treatment in a fairly short time . . . Points to a need and opportunity to provide dedicated and proactive patient support.” Eric Stanck Vice-President, Research, Medco
Sponsor Market Segments for Sponsor of Study – Drug Manufacturers – EHR systems that want to get closer to physicians and pharmacists – IT companies making healthcare products: Intuit, Qualcom, AT&T, T-Mobile, Cisco, – McKesson Increase transaction=makes more money and provide their IT System users with competitive advantage. – Device Companies: OMRON, LifeScan, Sanofi – Payments- Co-Branding of NFC Smart Stickers • 1Mn units at $20/unit (MasterCard and Discover interested) – OTC’s for Branded NFC Labels, Wallet Card and Cross Sell – Nutraceuticals- Branded NFC Labels, Cross Sell at Pharmacy – Chain Drug Store
$95Bn at Risk to Generic Competition in the US by 2014
Longer-term Upsides to Pharma Growth are Possible
REMS Programs and more active FDA safety program will bring new risk/benefit dynamic
Impact are Negative in the Short Term but more positive or uncertain in longer term
Key Biologics and U.S. Patent Expiries
Sales of Leading Therapy Classes
The Economic Crises Impacts All Stakeholders The danger for pharma is losing share of voice!

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$100Bn Public Health Problem–Poor Medication Adherence– David Parpart's Research

  • 1.
    “Increasing the effectivenessof adherence interventions will have a far greater impact on the health of the population than any improvement in specific medical treatments.” World Health Organization Confidential - Socially Relevant Inc. IMPACTMeds
  • 2.
    Meaningful Use ofHealth Information in US Confidential- Socially Relevant Inc.
  • 3.
  • 4.
    Projected Growth to$350-380Bn in 2016 73% ($) from Branded Sales $226Bn in Chronic Sales $227Bn in Retail Sales $188Bn in Losses Due to Poor Adherence Potential Market $508Bn $320Bn in US Rx Sales Confidential - Socially Relevant Inc.
  • 5.
    65,000 outlets 25 Companiesown 50%, 40% independent $227Bn in Rx Sales 95% of American Live within 5 miles 95% of American enter monthly Pharmacists are trained in medication adherence Retail Pharmacies Confidential - Socially Relevant Inc.
  • 6.
    • 2 in3 US Hospitals Fined for excess readmission (10/12) • Fines and standards will increase thru 2015 • Pre-admission medication list accuracy only 16% • 1 in 5 Medicare patients readmitted within 30 days with adverse drug events • Poor adherence Rated #1 cause of readmissions – Costing US insurers $100Bn+ in unnecessary hospital visits • 29% of Americans take 5 or more medications
  • 7.
    67% of People WhoNeed Medications Will Stop Buying Them Within 24 Month Confidential Do Not Distribute
  • 8.
    POOR ADHERENCE • FewerDrugs Sold • Poor Outcomes • Higher Costs • Hospital Admissions • Unnecessary Deaths 0 10 20 30 40 50 60 70 80 90 100 0 1 2 3 4 5 6 7 8 9 10 11 % Persisting Months on Lipid Lowering Medication
  • 9.
    Patients often sufferfrom unnecessary complications including heart attacks, strokes, heart failure, peripheral vascular disease, amputations. End-stage renal disease, retinopathy and vision loss.
  • 10.
    P O OR A D H E R E N C E M O N E Y & D E AT H T H E U N S A V O R Y N U M B E R S Confidential Do Not Distribute
  • 11.
    Confidential Do NotDistribute $350 billion in productivity losses $290 billion in additional hospital costs $188 billion in lost drug sales $100 billion in avoidable hospital visits 350 preventable deaths per day
  • 12.
    1,000,000 Unnecessary Deaths canbe Prevented this Decade with Improved Medication Adherence TogetherwecanmakeaBIG IMPACT!
  • 14.
    Adherence is arampant problem even among people undergoing Treatment for Dialysis, Transplants and Cancer
  • 16.
    SOURCE: Understanding andImproving Adherence for Specialty Products, IMS Chain Stores Food Stores Independent Mail Service
  • 17.
    0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of PrescriptionConsumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer Increase Prescription Sales by 59% with Improved Adherence 188 BILLION DOLLARS
  • 18.
    Increased Adherence =Incremental Sales # of Prescriptions Filled 0 100000000 200000000 300000000 400000000 500000000 600000000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Sales ($) Months Comparative Product Sales Existing System Income Additional Income (IMPACTMeds) = $3,134,339,366 Confidential Do Not Distribute
  • 19.
    Improving medication adherenceby only 25% across 65,000 retail pharmacies will increase sales by 33 BILLION DOLLARS
  • 20.
    What’s Missing? Social Factors Economic Factors HealthSystem Factors Patient-Related Factors Condition Therapy
  • 21.
    What can youdo to stop this growing crisis for healthcare stakeholders and the rising costs of poor adherence?
  • 22.
    “Medication Adherence isa $100Bn business opportunity” New England Health Institute, 2012 “…electronic monitoring devices, and pharmacist-led counseling are among the least costly intervention.” Roebucks M et al, Health Affairs, 2010 Confidential Do Not Distribute
  • 23.
    $180/mo. $3,172* ave. 24mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. Interactive Marketing Channel Labels *Assuming persistence increases sales by only 50% Confidential Do Not Distribute
  • 24.
    Improving adherence for Lipitor,Norvasc, Lyrica and Celebrex alone Would Increase sales by $6.5 billion dollars
  • 25.
    Estimated Annual Value $1000-1999M$2,000-4,999M $5,000M+ $100-499M $500-999M Assuming 20% of customers utilize pharmacist services and persistence increases sales by only 50%
  • 26.
    Estimated Annual Value $100-999M$1,000-1,999M $2,000M+ $396,000 $50-99M 28,000 Independently Owned Pharmacies Assuming 66 new customers per/mo./pharmacy utilize services and persistence increases sales by only 50% for one brand name medication
  • 27.
  • 28.
    Improving medication adherence inthe US is capable of reducing national health spending by 5.5% (0.98% of GDP) SOURCE: IMS 2012
  • 29.
    350 BILLION DOLLARS inproductivity losses for US employers is due to poor medication adherence for only five conditions SOURCE: Booz & Company 2012
  • 30.
    The Gold StandardSolution 14 years of clinical trials conducted by the American Pharmacy Association demonstrate an increase in drug sales by 2x and adherence by 3x Project IMPACT
  • 31.
    0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of PrescriptionConsumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer 12 15 18 21 24 0 5 10 15 20 25 Current Model 25% 50% 75% IMPACT Trials 24 mo. Sales (#) Adherence Increase IMPACT Clinical Trials Increase Prescription Sales by 104%
  • 32.
    0 10 20 30 40 50 60 70 80 90 100 0 1 23 4 5 6 7 8 9 10 11 % Persisting Months on Medication • 2x Sales Increase • 90-93% Persistence at 24 months • High Patient Satisfaction Pharmacists-LedCounseling
  • 33.
    Leading the Industryin Pharmacy Research and Expanding the Role of Pharmacists in Health Care
  • 34.
    Prize Winner ofthe Sanofi US Innovation Challenge Specializing in Medication Adherence
  • 35.
  • 36.
    E A SY T R A C K I N G A T H O M E • “Caring” Reminders • Track Administration • Positive, Side Effects and Adverse Events • Self-Monitoring of Biometrics • Food Consumption Confidential- Socially Relevant Inc.
  • 37.
    T O OL S F O R C A R E G I V E R S Confidential- Socially Relevant Inc.
  • 38.
    I N TE R A C T I V E L A B E L S F O R S M A R T P H O N E S • Convenient Way to: • Track Medication Administration • Track Biometrics • Purchase Refills For Marketers NFC vs. QR • 12x higher Tap rate • 5-10x time on site (48 sec vs. 5-10 sec) • 36% tap to action rate Confidential- Socially Relevant Inc.
  • 39.
  • 40.
    Prepaid MedCredits Name: Patient No: Signature: ACO_________________________ Manufacturer _________________________ Insurance _________________________ John Doe A987654 Employer _________________________ Date: 04/30/13 100 200 400 QTY MedCredits Get answers to medication questions for free and receive special care. Redeem Med Credits at your local pharmacy or www.IMPACTMeds.com Med Credits expire in 60 days. Ask your pharmacist for more. Special Care Provided by: ™ ™ The Users’ Experience Medicare Part D Dallas Nephrology
  • 41.
  • 42.
    Predictive Algorithms andIndexes Analytics and Predictive Algorithms Readmission Risk Index Uses EHR Data to Predicts Readmission Risk & Future Days in Hospital Non-Adherence Risk Index Predicts Medication Non-Adherence Flags Patient on Providers’ Case Manager Screen Stimulate Early Personalized Intervention Confidential- Socially Relevant Inc.
  • 43.
    We Provide Pharmacistsand Patients with Simple Tools to Improve Medication Adherence Confidential - Socially Relevant Inc. IMPACTMeds
  • 44.
    The World’s Largest MedicationAdherence Program Launching Spring 2013 Opportunities Available • Strategic Partnerships & Alliances • Program Sponsorship Join us now and play a leading role! IMPACTMeds
  • 45.
    Contact information: BenjaminBluml,R.Ph. VP Research APhAFoundation www.APhAFoundation.org 2215 Constitution Ave. NW Washington, DC 20037 202-429-7571 bbluml@aphanet.org DavidParpart,D.C. CEO iRetainRx www.iRetainRx.com 440 N Wolfe Rd. Sunnyvale, CA 94085 408-329-9344 Ext:1001 drparpart@sociallyrelevant.com IMPACTMeds Confidential - Socially Relevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence
  • 46.
    Easy-to-use mobile appsand NFC labels for interactive medication reminders, education and tracking usage MOBILE ENGAGEMENT
  • 47.
    MedCredits iRetainRx Specializes in RetentionMarketing for Medications. Med Credits provide Manufacturers & Retailers with a Simple Mechanism to Invest in Retaining High Value Customers
  • 48.
    MedCredits 1.) Manufacturers &Retailers Select High-Value Customers and Provide Their Customers with Med Credits. 2.) Customers use Med Credits Virtual Currency to Purchase Services and Tools that Improve Medication Adherence and Sales, such as Pharmacist Counseling, NFC Sticker, Glow Caps etc.
  • 50.
    The Users’ Experience TheClinic/Pharmacy personal device report in stantly ac c essib le to d oc tors an d p h armac ists At Home u se mob ile or computer to upload, share and view p erson al p rofile d ata Confidential Do Not Distribute
  • 51.
    Co-operative Marketing IMPACTMeds enablesstakeholders to dramatically increase medication adherence, something they have been unable to scale despite $188Bn in Losses
  • 52.
    Co-operative Marketing IMPACTMeds enablesstakeholders to dramatically increase medication adherence and customer lifetime value (LTV), something they have been unable to scale despite $188Bn in Losses
  • 53.
    $180/mo. $3,172* ave. 24mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. *Assuming persistence increases sales by only 50% Pfizer Pharmacy Months to Discontinue Current Lipitor Sales $2,106 2,106 12 Sales with IMPACTMeds $3,172 $3,172 18 Increased Sales $1,066 $1,066 6 Pfizer Pharmacy Patient APhA and iRetainRx IMPACTMeds Marketing Distribution ($550) $275 $180 $95 Co-operative Marketing EXAMPLE 1
  • 54.
    $180/mo. $4,120* ave. 24mo. Sales/pt. iRetainRx Now $180/mo. $2,106 ave. 24 mo. Sales/pt. *Project IMPACT Hyperlipidemia persistence rate Pfizer Pharmacy Months to Discontinue Current Lipitor Sales $2,106 2,106 12 Sales with IMPACTMeds $4,120 $4,120 23 Increased Sales $2,034 $2,034 11 Pfizer Pharmacy Patient APhA and iRetainRx IMPACTMeds Marketing Distribution ($860) $500 $230 $130 Co-operative Marketing EXAMPLE 2
  • 55.
    Poor Adherence Costs $188Bn Lost Lost$’s / Penaltie s $290Bn Costs $125Bn Lost $188B n Lost Pharmacists /Manufacturers $188Bn Lost Sales Insurers/Employers $290Bn in add’l Costs $100Bn Unnecessary Hospital Visits Employers $125Bn in Productivity Losses Doctor and Hospitals Less ACO/PCMH Revenues Readmissions Penalties Consumers Strokes, Heart Attacks, Suicide, Amputations etc.
  • 56.
    Patients often sufferfrom unnecessary complications including heart attacks, strokes, heart failure, peripheral vascular disease, amputations. End-stage renal disease, retinopathy and vision loss.
  • 57.
    Confidential- Socially RelevantInc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence IMPACTMeds Incentive Slide for Employers/Insurers and the Government
  • 58.
    Improving medication adherenceby only 25% just for Lipid Lowering Drugs would increase Pharmaceutical sales by 3.6 BILLION DOLLARS SOURCE: Comparing Adherence & Persistence, J Managed Care Pharm and 2011 industry data from IMS
  • 59.
    Improving medication adherenceby only 25% just for Diabetes Drugs would increase Pharmaceutical sales by 2.9 BILLION DOLLARS SOURCE: Estimated Annual Pharmaceutical Revenue Loss Due to Medication Adherence, Capgemini Consulting
  • 60.
    127 BILLION DOLLARS inproductivity losses for UK and German employers is due to poor medication adherence for only five conditions SOURCE: Booz & Company 2012
  • 61.
    SOURCE: Booz &Company Improved medication adherence is capable of producing € 20Bn to € 43Bn in productivity gains for employer in the UK, Germany and the Netherlands
  • 63.
    Confidential- Socially RelevantInc. Participating Pharmacies Delivering IMPACT Persistence: 90-93%
  • 64.
    • IMPROVED PATIENT HEALTH •INCREASED PROFITS • NEW REVENUE STREAMS • INCREASED PATIENT ENGAGEMENT, LOYALTY & STICKINESS • IMPROVED EFFICIENCY • TECHNOLOGY SOLUTIONS • DRUG MANUFACTURERS • PHARMACIES • ACOs & PCMHs • HOSPITALS • SPECIALITY MEDICAL GROUPS • HEALTH IT & MOBILE DEVELOPERS WHO WE SUPPORT WHAT WE PROVIDE OUTCOMES DELIVERED • MULTI-SYSTEM INTEGRATION • CROSS-PLATFORM DELIVERY • ADHERENCE EXPERTISE • EASY TO IMPLEMENT ADHERENCE TOOLS & TECHNOLOGY • PATIENT-CENTERED OUTREACH & SUPPORT • PATIENT EDUCATION • ADHERENCE RESEARCH & RISK ANALYSIS Confidential- Socially Relevant Inc. IMPACTMeds
  • 65.
    Gives Prescription (Rx) toPharmacy Employee Fills Out Patient Profile Adherence Risk Assessment Arrive at Pharmacy Greets Customer (RPh/Tech) Personalized Receives & Checks Rx (RPh/Tech) Computer Entry (Tech) Fill Rx (Tech) Ok’d byRPh Pharmacy Exterior Parking Appearance of Non-pharmacy Departments Employee Dress Non-prescription Merchandising Waiting Area Patient Information Brochures Signs Line of Interaction Line of Internal Interaction Line of Visibility Clarification Needed? Yes No Calls MD’s Office(RPh) Drug Interaction or DUR Notification? Do not fill Insurance DUR Notification Check Rx (RPh) Clarification or Change Made with Rx Profile Reviewed (RPh) Picks Up & Pays for Rx Is Counseled About Rx Tablet Visual Aids Appearance of Rx Labels Appearance of Drug Bill Drug Information Insert Mobile Application Medication Wallet Card Presents Bill for Rx and Merchandise (RPh/Tech) Counsels Patient (RPh) MTM Dashboard for Targeted Interventions Service Blueprint for Dispensing Services
  • 66.
    M E DI C AT I O N D O C U M E N TAT I O N E X C H A N G E The Basis For Scalable Medication Adherence Confidential- Socially Relevant Inc. 66 Community Pharmacies General Practitioners Dispense and Prescription Queries E-Prescriptions Dispense References Care Information Broker (Act Registry) PRESC GP1 PAT1 PRESC GP1 PAT2 PRESC HOSP1 PAT1 … DISP PHARM1 PAT1 DISP PHARM2 PAT2 … ADVICE PHARM1 PAT1 ADVICE PHARM1 PAT1 Med Administration Self-Monitoring Patient Generated Advice, Education & Counseling (MTM) PHARM Laboratory Hospital Dependance Pharmacy GP GP GP centre Hospital
  • 67.
  • 68.
  • 69.
  • 70.
    0-4 78,785,312 5-17 317,613,579 18-44 1,049,101,771 45-64 1,760,172,012 65-74 686,144,356 75-84 436,241,475 85+ 185,128,692 # of Prescriptions Filled Age of PrescriptionConsumers (US) Age of Consumer 0 500,000,000 1,000,000,000 1,500,000,000 2,000,000,000 2,500,000,000 3,000,000,000 0-4 0-5-17 18-44 45-64 65-74 75-84 85+ Impact of Secondary Adherence Impact of Primary Adherence Current Prescription Sales # of Prescriptions Filled Age of Consumer Current Model 25% 50% 75% IMPACT Trials Sales 11.6 14.6 17.6 20.6 23.6 0.0 5.0 10.0 15.0 20.0 25.0 24 mo. Sales (#) Effect of Increased Adherence on Life Time Value IMPACT Clinical Trials Increase Prescription Sales by 104% Adherence Increase
  • 71.
    • Administer PatientAssistance Programs • Risk Evaluation Mitigation • Corporate Social Responsibility– Track Impact and ROI More Opportunities For Manufacturers
  • 72.
    Data: Adherence andPersistence What data do we want to capture? At Pharmacy: Patients’ adherence knowledge, skills and performance Pharmacists interventions and medication documentation Claims and persistence At Home: • Medication administration • Self Monitoring- Glucose, BMI, A1C, BP • Meds Dose/response relationship • Diet • Exercise • Positive, Side Effects and Adverse Events • Anthropometric How do interventions affect adherence and persistence? How does adherence in one intervention relate to other interventions? Anatomized Data Provided for Safety Analysis
  • 73.
    Imp rove Patie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt IMPACTMeds
  • 74.
    Imp rove Patie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt Adherence Solutions •Safety; Side effects; Efficacy •Self-Care Patient Education •Mobile •Telephone IVR Reminders •Synchronize Refills •Frequency Simplify Dosing Regimen •Payment Assistance Programs •Rewards programs Costs •Blister Packs Specialty Packaging •Laboratory Tests •Self-Care Disease Management •Doctors •Family Caregivers Coordination of Care
  • 75.
    0 50000000 100000000 150000000 200000000 250000000 300000000 350000000 1 2 34 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Income ($) Time (in months) Comparative Product Income Existing System Income Additional Income (Project ImPACT: 2012) = $1,399,356,000 Additional Annual Sales in Texas and California Alone Increased Retention– Manufacturer Profits
  • 76.
  • 77.
    Getting and annualflu shot Avoid overeating Getting enough exercise Getting enough sleep Eating a healthy diet Avoid smoking Taking medication as prescribed Most Important Health Behavior , All Respondents 4 0 , 0 0 0 R a n d o m l y S e l e c t e d A m e r i c a n s 1 8 o r O l d e r C u r r e n t l y Ta k i n g M e d i c a t i o n U s e d t o T r e a t a t L e a s t O n e C h r o n i c C o n d i t i o n When survey participants ranked the importance of several health behaviors MEDICATION ADHERENCE WAS VALUED AS THE MOST IMPORTANT!
  • 78.
    Retention Risk Index Doctor Visits PharmacyRefills Help People Take Medication Correctly
  • 79.
  • 80.
    P h ar m a c i s t s E n g a g e P a t i e n t s a n d C a r e g i v e r s i n A d h e r e n c e A s s e s s m e n t , C o u n s e l i n g a n d E d u c a t i o n Grandpa’s Story
  • 81.
    While many interventions(e.g. education in self-management (25-34); pharmacy management programmes (35,36); nurse, pharmacist and other non-medical health professional intervention protocols (37-43); counselling (44,45); behavioural interventions (46,47); follow-up (48,49) and reminders, among others), have been shown to be effective in significantly improving adherence rates (50-54), they have tended to be used alone. A single- factor approach might be expected to have limited effectiveness, if the factors determining adherence interact and potentiate each other's influence as they are likely to do. The most effective approaches have been shown to be multi-level - targeting more than one factor with more than one intervention. Several programmes have demonstrated good results using multilevel team approaches (55-57). Examples include the Multiple Risk Factor Intervention Trial Research Group, 1982 (58) and the Hypertension Detection and Follow-up Program Cooperative Group, 1979 (59). In fact, adequate evidence exists to support the use of innovative, modified health care system teams rather than traditional, independent physician practice and minimally structured systems (60,61). Various interventions are already being implemented by many different health care actors. Although not all of these actors are directly responsible for providing health care, they nevertheless have an important role in improving adherence because they can influence one or more of the factors that determine adherence. The work that is being done to improve adherence and the persons performing the work are described below. Excerpt from World Health Comprehensive/Personal Approach. No one-size fits all.
  • 84.
    Confidential- Socially RelevantInc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence IMPACTMeds
  • 85.
    Confidential- Socially RelevantInc. Why Does IMPACT Improve Medication Adherence? Patients Explain, “I Feel My Pharmacist Cares” IMPACTMeds It’s NOT a Tough Egg to Crack Internal Forces Applied to Break an Egg Generates New Life
  • 86.
    Confidential- Socially RelevantInc. People Persist on Medications they BELIEVE are Important from Pharmacists that CARE IMPACTMeds It’s NOT a Tough Egg to Crack Internal Forces Applied to Break an Egg Generates New Life
  • 87.
    IMPACTMeds Confidential - SociallyRelevant Inc. We Provide Pharmacists and Patients with Simple Tools to Improve Medication Adherence
  • 88.
  • 89.
  • 90.
    iRetainRx Now Distribution of BrandInformation F DA & B ra n d e d P r i n t a t P o i n t - o f - C a re We b s i t e s At H o m e A p p s F DA & B ra n d e d P o i n t - o f - C a r e O n - t h e - G o Confidential Do Not Distribute
  • 93.
    Benefits to Sponsors •First Look/Priority Access to Stats and Data • PR/Marketing Brand Awareness • Premium Networking Opportunities • Brand Visibility • Advertising and Educational Marketing to Providers Doctors and Pharmacists • Co-Branding of Consumer Hardware NFC Labels and NFC Smart Stickers Personal Medication Record Wallet Card
  • 94.
    • Increase Adherence& Sales • Increase Brand Awareness • Increase Brand Loyalty • Extend Brand Name Product Life • Competitive Advantage & Differentiation • Improved Patient Outcomes • Increased Prescription Rate • Personal Channel • Opt-in Education Marketing Channel • Integrated Education & Purchasing • Access to New Innovative Value Layer for Adherence Stakeholders Benefits For Manufacturers
  • 95.
    • Monthly RxCost >$80 • Losses From – Rapidly Declining Persistence – Missed Doses – Generic Competition – Class Competition • Medium to High Margins • Customer Retention Marketing Budget Benefiting Products
  • 96.
    Premium Networking Opportunity ForMedication Adherence Stakeholders • Pharmacies • Pharmaceutical Manufacturers • Medical Groups, PCMH & ACOs • Specialty Medical Groups • Employers/Insurers • Governments • Pharmaceutical Distributers • State and Nation Associations • Payments and Credit Cards • Information Technology • Telecommunications IMPACTMedsCONFERENCES
  • 97.
      Part 1of 5 – PSPC Overview Website: http://www.hrsa.gov/publichealth/clinical/patientsafety/index.html
  • 98.
     US Departmentof Health and Human Services  Health Resources and Services Administration (HRSA) o Improving access to health care services for people who are uninsured, isolated or medically vulnerable. o Healthcare Systems Bureau - Office of Pharmacy Affairs provides leadership and oversees the 340B program as well as PSPC 98 PSPC Overview
  • 99.
     More than133 million Americans live with chronic illnesses1  91% of all prescriptions filled for a chronic condition2  1.5 million people are injured each year as a result of medication3  Uncoordinated care costs an estimated $240Billion/year 4 99 1. CDC National Center for Chronic Disease Prevention and Health Promotion: Chronic Disease Prevention http://www.cdc.gov/nccdphp/overview.htm 2. American Heart Association. Heart Disease and Stroke Statistics–2008 Update. Dallas, Texas: American Heart Association; 2008.http://www.americanheart.org 3. Institute of Medicine (IOM), To Err Is Human: Building a Safer Health System, Washington, DC: National Academy Press; 2000 4. Owens, MK “The Health Care imperative: Lowering Costs and Improving Outcomes”, The Institute of Medicine, 2010 PSPC Overview
  • 100.
    WHAT: Quality ImprovementCollaborative aimed at improving health outcomes and patient safety for high- risk patients (Adapted IHI Breakthrough Series Collaborative Model) Improve the delivery system where there are gaps by: o Enhancing care coordination among the providers and partners involved o Fostering multidisciplinary, team based care approach o Strengthening patient centered medical home o Integrating medication management and other services to minimize harm related to adverse drug events and maximize optimal health outcomes 100 PSPC Overview
  • 101.
    PSPC 5.0 AIM: Inter-professionalteams that improve the health outcomes and safety for high medication risk populations through patient-centered, cost-effective medication management services aligned with quality national standards. PSPC’s vision: To engage 3,000 communities in the US who will have integrated care teams that will ensure optimal health outcomes and safety for every patient. 101 PSPC Overview
  • 102.
    The transformational goalof the PSPC:  Integrate the healthcare delivery system, across multiple healthcare partners, to create a service delivery system for high-risk patients that will produce breakthroughs in the following three areas: o 1) Improved patient health outcomes o 2) Improved patient safety o 3) Increase utilization of cost-effective and integrated medication management services 102 PSPC Overview
  • 103.
    WHO: Community basedteams across the country o Organizations include safety net provider and hospitals, public health departments, and HIV clinics o Partners include colleges of pharmacy, primary care associations, and Quality Improvement Organizations o Multidisciplinary care teams delivering patient centered services to improve medication safety and health outcomes This is about saving patient lives! 103 In our 4th year (2011-2012), we had over 200+ community based teams from 48 states + DC, PR and VI participate! PSPC Overview
  • 104.
     In our3rd year (2010-2011)* some of the accomplishments include: o The 39 Teams tracking improvement for the Diabetes PoF reported an average improvement in the health status marker of 35% o The 12 Teams tracking improvement for the Hypertension PoF reported an average improvement in the health status marker of 40% o Teams also reported a decrease in the average number adverse drug events (ADE) from 0.7 to 0.5 ADEs per patient. o The average number of potential errors per patient decreased from 1.5 per patient encounter at start up to 0.8. o In 2011, APhA Foundation honored PSPC with the Pinnacle Award for being able to demonstrate approaches that assist patients and their caregivers in achieving better outcomes from their medications *4th year accomplishments still being compiled 104 PSPC Overview
  • 105.
     Patient-Centered  InterdisciplinaryCare Team  Cross-Organizational with Health Homes at the Center  Systematically Addresses Medication Management, Safety and Risk -- Huge Issues for Ambulatory Care Patients  All Teach, All Learn  Align with national efforts (ex: Partnership for Patients) It Is Truly the Next Generation of Collaboratives! 105 PSPC Overview
  • 106.
  • 107.
    Consider the impactof this non-compliance on both the manufacturer of Plavix and the healthcare system as a whole. Bristol-Myers Squibb reported $2B in sales of Plavix in 2010. With an 83% compliance rate within the first four months of therapy, THERE COULD BE $400MM OF LOST REVENUE EVERY FOUR MONTHS. THIS TRANSLATES INTO$1.2B ANNUALLY IN LOST REVENUE DUE TO NON-ADHERENCE. Prior to the patent expiration of Plavix, there were an estimated 4MM patients on Plavix. In addition to these patients, there are an additional 3MM patients on Coumadin and other anti- platelets. If there is a similar non-adherence rate for Coumadin and other anti-platelets, the TOTAL ANNUAL REVENUE LOST FOR THE PHARMACEUTICAL INDUSTRY IS OVER $2B. Adherence is hindered by two factors 1.) the lack of disease and therapy specific information and tools for adherence and 2) the limited ability for the pharmaceutical industry to have interaction with the patients. “We are seeing a sizable portion of patients drop off treatment in a fairly short time . . . Points to a need and opportunity to provide dedicated and proactive patient support.” Eric Stanck Vice-President, Research, Medco
  • 110.
    Sponsor Market Segmentsfor Sponsor of Study – Drug Manufacturers – EHR systems that want to get closer to physicians and pharmacists – IT companies making healthcare products: Intuit, Qualcom, AT&T, T-Mobile, Cisco, – McKesson Increase transaction=makes more money and provide their IT System users with competitive advantage. – Device Companies: OMRON, LifeScan, Sanofi – Payments- Co-Branding of NFC Smart Stickers • 1Mn units at $20/unit (MasterCard and Discover interested) – OTC’s for Branded NFC Labels, Wallet Card and Cross Sell – Nutraceuticals- Branded NFC Labels, Cross Sell at Pharmacy – Chain Drug Store
  • 111.
    $95Bn at Riskto Generic Competition in the US by 2014
  • 112.
    Longer-term Upsides toPharma Growth are Possible
  • 113.
    REMS Programs andmore active FDA safety program will bring new risk/benefit dynamic
  • 114.
    Impact are Negativein the Short Term but more positive or uncertain in longer term
  • 115.
    Key Biologics andU.S. Patent Expiries
  • 116.
    Sales of LeadingTherapy Classes
  • 117.
    The Economic CrisesImpacts All Stakeholders The danger for pharma is losing share of voice!