How to fix your adherence problem

Typical patient support programs fail to improve adherence - and it’s costing the pharma industry billions. Here’s how to do a better job.

No matter how effective a treatment is, if patients don’t fill their prescriptions and take the medication as directed, they won’t benefit and the product won’t sell. It may seem like an obvious statement, but pharma companies often fail to effectively manage this final leg of the sales process, and it is costing them money while leaving patients vulnerable to incomplete care.

Lack of adherence to medication is a huge problem in the healthcare industry. Nearly one-third of all prescriptions are never filled, with the highest levels seen among high-cost specialty drugs. That means pharma companies are literally losing one-third of their customers before a single transaction occurs. A review in the Annals of Medicine found non-adherence causes roughly 125,000 deaths and at least 10 percent of hospitalizations per year, while costing the pharma industry billions in lost revenues.

So why aren’t these companies doing more to stem their losses? In part, because they rely on old commercialization strategies that do little to address many of the barriers patients face in their care.

Beyond the co-pay

Most pharma companies do implement support programs that are intended to help patients get over the hurdle of accessing treatment, however these programs usually consist of isolated transactions, such as call centers and web forms, with little integration between channels.

This can be frustrating for patients and provides little if any insight to the pharma companies about whether these support services are actually working. Typically, the success of these programs are measured by call volume or site visits, but there is no way to track whether that “support” translated to actual prescriptions filled much less the long term clinical outcomes expected for the product.

Worse, most of these support interactions focus on only two obstacles in the patient care journey – out-of-pocket costs, and financial access. These are certainly important factors for patients in their treatment decision-making and initiating therapy, but they are hardly the only issues that affect adherence.

Patients face many social, emotional and physical issues that prevent them from participating in their prescribed treatment. A recent World Health Organization report studying adherence to long-term therapies, found that medication-adherence is the result of multiple interrelated factors, including social and economic issues, fears about side-effects, the quality of a patient’s healthcare team and support system, the characteristics of the disease, and their willingness to accept the diagnosis. “Solving the problems related to each of these factors is necessary if patients’ adherence to therapies is to be improved,” the authors concluded.

Unless pharma companies address all of these issues, they are essentially abandoning a large segment of their customer population who might be easily transitioned to adherent, loyal users with a little extra emotional support.

Adherence nearly triples

Fortunately, there are many ways pharma companies can engage with patients to help them overcome all of the barriers to adherence -- and they don’t all require in-home visits. Patient engagement can be conducted via a variety of channels, including face-to-face meetings, phone calls, and digital connections to help guide them through their care journey. The key is crafting a strategic engagement plan that not only addresses all obstacles to care in the most efficient manner possible, but creates a personal touch.

Introducing people, systems, and operations with a longitudinal patient relationship in mind instead of point-of-service, transactions becomes critical.  From a people perspective that may include providing dedicated patient support individuals to help patients one on one. Enabling those individuals with a multi-channel digital engagement and relationship management system linked to a centralized database allows support staff to see instantly when and why a patient called in the past, and to provide personalized, proactive services relevant to the patient at any point in their journey. Such integrated, proactive support infrastructure is commonplace in the clinical trial environment, but not in the commercial environment. By taking the same focused approach to patients in the real, pharma companies can generate a much stronger rate of engagement and adherence, and thus greater patient impact and financial return.

These programs are admittedly complex to create and can be more costly than hosting a call center, particularly if patients need face-to-face training and support with a dedicated professional trained to address their unique needs, but the return on the investment can be significant. We have found that patients who receive this added level of support show much higher rates of  long-term adherence, which directly translates to increased revenue for the developers of these drugs. In one example, we saw 12-month persistence levels – measuring patient adherence to a treatment – jump from less than 30 percent to 85 percent in one year.  This outcome was thanks to a support program that provides patients with access to personalized, dedicated healthcare expert who works with them to address any barriers they face in filling their prescriptions, dealing with their disease, and maintaining therapy.

Ensuring scalablity and efficacy

While one-on-one support is the idea, these programs can also be scaled to fit the commercial budget and needs of patients by implementing lower cost support channels, and reducing the level support for those patients who have overcome their barriers. Automatic call routing allows patients to reach their dedicated support individual each time they call for a seamless patient experience.

Once they are implemented, the impact of these programs can be measured through operational metrics such as follow-up calls, emails, and texts, but the real value comes from adding engagement metrics to determine whether patients enrolled in the support program, filled their prescriptions, and are using the treatment appropriately.  This kind of feedback lets pharma companies determine whether their engagement channels are meeting goals – and where changes need to be made. For example, if a support center consistently get high marks for helping patients address payment issues, but low marks for helping patients facing emotional barriers to using a new drug, they can rework their offering to better address this need. Pharma companies can also use external data sources, including registries, electronic health records, and claims data to look for trends in prescriptions filled and refilled in a specific region to correlate engagement efforts with increased adherence.

In fact, the outcome is more than just clinical impact and prescription volume.  Reps are seeing the value of these support services for physicians and their practices, and this is leading to more time in the office.  Patients enrolled in the programs are getting their therapy quicker.  Manufacturers are demonstrating improved Health Economic Outcomes data to payers.  Essentially, “what good looks like” is getting closer to the impact on patient care across all stakeholders.

Implementing these engagement solutions isn’t easy, but it is worth it. The success of a pharma product is dependent on whether patients will adhere to the treatment. When pharma companies integrate patient engagement based on longitudinal relationship building rather than transactions and acknowledge the need to address all of the hurdles patients face in accessing these products, then they can improve adherence rates, which translates to measurable benefits for pharma, patients and the overall healthcare community.

About the author

Paul Harney is Vice President, Solutions Design Centre, Integrated Engagement Services, QuintilesIMS

A veteran of the healthcare and life sciences industry, Paul joined Quintiles in 2015 with the overarching goal to help customers achieve and sustain peak commercialization faster through better market access and channel strategies. His extensive experience with retail and institutional products covers several therapy areas, such as diabetes, respiratory, anti-infectives, urology, vaccines and dermatology.

Prior to joining Quintiles, Paul held leadership roles at various consulting firms that engaged biopharmaceutical companies in nearly all functional areas, including sales, marketing, medical affairs, business development and supply chain. Paul graduated with a bachelor’s degree in chemistry from Trinity College in Hartford, Conn., and holds a doctorate in philosophy from State University of New York at Stony Brook.

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