Pharmacists: the link to the lost patient
Pharma companies need to reassess their view of pharmacists, whose roles increasingly extend beyond over-the-counter products, making them valuable partners in providing true patient centricity.
The term ‘patient centricity’ is widely used today but, more often than not, it is an empty and meaningless phrase.
Delivering support to patients is usually a missing parameter in an equation designed to create more sales and increase profitability.
In addition, the pharma industry’s traditional sales model, seemingly engraved in its DNA, keeps it in ‘selling mode’ at all times. Direct-to-patient promotion is forbidden in most countries outside the US, which could be one reason why links with patients are missing. Yet regulatory restrictions are often welcomed as reasons not to engage, obstructing beneficial ties or even partnering with patients.
Pharma companies are sitting on a wealth of knowledge about particular diseases, their diagnosis and treatment. If this knowledge were designed to support patients, this valuable asset could be leveraged as an important driver towards improved patient outcomes.
Furthermore, pharma could help improve cost effectiveness in healthcare, taking a pivotal role in supporting patients, physicians, pharmacists and even payers in their common goal of getting more for the same investment.
Receiving a diagnosis for a chronic condition must be acknowledged as a life-changing event. Be it allergy, diabetes, rheumatism, hypertension, COPD or asthma, any diagnosis, even at the earliest possible stage, immediately converts you from a ‘normal’ human being to a patient.
The majority of patients fail to fully understand all the details around their specific condition. Facing the complexity of tests, laboratory, x-rays, diagnoses, the prescription of a drug and other recommendations takes so much time and energy that they are unlikely to considerably change their daily habits without a lot of support.
“The common denominator benefitting everyone involved in healthcare is therapy adherence”
Once the diagnosis is made, physicians can only be successful if the patient adheres to therapy. Only if and when patients adhere to therapy will payers get what they paid for. Adherent patients will, in turn, usually be happy, since the burden of their disease is alleviated or removed. Pharmacists are happy when patients adhere to treatment, since they will return for repeat prescriptions. Politicians, in turn, are happy, because they see the funds invested in the health of their citizens being rewarded.
However, fragmented healthcare and business systems are preventing the achievement of this common objective.
Traditionally, decades ago, pharma companies separated their distribution channels, based on an inside-out perspective: “Our drugs are divided into Rx and non-Rx.”
The subsequent splitting of channels, activities, departments or business units was almost unavoidable and became standard across the industry:
• Physicians made the decisions on Rx. This meant the number one distribution/sales channel became Rx.
• Pharmacists made the decisions on over-the-counter (OTC) drugs. This became the secondary distribution/sales channel.
Neither of these longstanding assumptions apply today. Now, Rx decisions are made by political bodies, tenders, contracts, guidelines etc, while most purchasing decisions around OTC drugs, are made by the buyer, driven by ads on TV and other channels.
The patient journey lies far from those antiquated structures that still prevail in the industry.
How can pharma deliver improved patient outcomes when it misses the chance to follow the patients along their journeys?
Often the first port of call with a health issue is to take the easiest and most convenient route and walk into a pharmacy. Patients will ask the pharmacist for an OTC drug or request advice on their problem. The qualified pharmacist plays a trusted role for patients so once a patient perceives the situation is serious enough, or has been advised by the pharmacist to do so, he or she will see a physician.
The key task and responsibility of a physician is to establish a diagnosis. Consequently therapy will be started, based on guidelines, evidence or availability of a therapeutic solution. In the vast majority of cases, therapy will include the prescribing of a drug. Again, the patient will go back to the pharmacist for the prescription to be filled.
Meanwhile, political decision makers are planning to leverage the pharmacists’ education and expertise to free crowded doctors’ surgeries from the burden of issuing repeat prescriptions, which is, I believe, the correct approach. So in future it will be the pharmacist to fill repeat Rx for the chronically ill.
When generic prescriptions are asked for or available in a country or market, it is the pharmacist who decides which drug will be dispensed. Of course the decision will be discussed with the patient, taking into account the patient’s history, often built up over many years of visits to the pharmacy. Pharmacists know that customers who receive good service tailored to their needs will return in future.
In addition, pharmacists are a central anchor point for therapy adherence, a fact backed by research undertaken by IMS Health. Every day, pharmacists are asked for advice, hold consultations, have the most regular (low threshold) contact with patients and are a trusted source for patients’ information.
The traditional sales model and the current structure of the pharma industry mean pharmacists have been overlooked as a means to improve patients’ lives. High, and mostly unsurmountable, walls remain between the Rx and OTC businesses, keeping physicians as the major targets for Rx and pharmacists on the OTC side. Comments like: “Our reps visit two pharmacies a day in addition to 10 doctors” show many in the industry are not reaping the full benefits they could.
“84% of pharmacists asked for more support from pharma to help them improve therapy adherence in patients”
This is why, earlier in 2015, an embarrassing 76 per cent of German pharmacists claimed they were not sufficiently informed by the pharma industry about a newly-launched anti-diabetic drug. Similarly 84 per cent of them asked for more support from pharma to help them improve therapy adherence in patients. Do these results appear astonishing or new? Not really, given the context of this article.
Pharma’s sales model is designed to generate revenue from drugs and the majority of companies still employ sales forces of reasonable size dedicated to selling those drugs to physicians. This supposedly leads to prescriptions, which are filled by patients in the pharmacy. There is no room for pharmacists in their plan and subsequently patients are lost and patient centricity remains a meaningless phrase.
When pharma companies stop trying to ‘sell’ drugs to physicians – misleadingly called customers, as they do not even buy – and start to contribute actively to better patient outcomes, they will be rewarded. What returns they receive will be determined by how much they do. By acting to help patients, they will improve the industry’s reputation, pharma people will be invited to meet with physicians and then cross-functional collaboration with health care providers will activate improved patient outcomes. Of course it is easy to see that such actions will result in greater revenues.
About the author:
Hanno Wolfram is the founder and owner of www.Innov8.de, a Germany-based firm offering consultancy for pharmaceutical companies. He is the author of KAM in Pharma 3.0, an international textbook about Key Account Management in pharma.
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