It is estimated that medication non-adherence accounts for approximately $637 billion in revenue opportunity losses for U.S. pharmaceutical manufacturers. The root causes: lack of initial alignment between provider and patient and inadequate follow up with patients once the prescription is written.

Time pressure and competing priorities lead to lack of medication alignment

The lack of initial alignment regarding prescribed therapies has many causes. What potentially disrupts the first fill and later, the first refill?

It’s a matter of time and trust in the precious minutes or seconds the physician shares with the patient.

Physician/patient interaction time is increasingly tightly constrained, with some surveys suggesting that physicians only spent 27% of their total time on direct clinical face time with patients. This time is inclusive of symptom evaluation, diagnosis, listening to the patient, and more.

Frequently, less than one minute spent within those visits is given to the “what and why” about prescribed medication therapies, including side effects. Failure to adequately explain what the medication is and why it is important is a massive barrier to compliance. However, time pressures are very real. Frequently patients don’t want to take any more of the doctor’s time than what they perceive as needed. Or perhaps they want to complete the visit as quickly as possible after spending a lot of time in the waiting room. Lack of time with the provider can also tempt patients to consult unreliable outside resources like the dreaded Dr. Google.

Often, even if patients know why medications and compliance are important, they still don’t know what to expect from therapy, particularly in terms of side effects and drug-drug interactions.

Failure to personalize, and persist in, follow up with patients

With barriers to medication adherence being multifactorial in nature, the keys to creating a successful solution are real-time layered interventions and versatility. It is determined that a tailored approach with built-in flexibility and engagement options provides the best experiences for patients and thus, increases their medication adherence. Integrating levels of intervention and technology can address adherence at various touchpoints of the patient’s journey, making it a more robust adherence program. Real-time data analytics is crucial especially for therapy classes with high discontinuation curves. When support intervention teams are equipped with real-time intelligence about medication utilization, they can address the right patients with the right message at the right time to increase persistency.

From accounts of various adherence programs, it’s not that a specific technique is ineffective, it is simply incomplete. It’s a matter of preference and timing— some patients respond to the initial intervention (e.g. audio/visual reminders) and others respond to the latter intervention (e.g. nurse support call). Often with support adherence programs, their common limitation is implementing a single strategy against the entire patient population. There needs to be a degree of flexibility and options to target adherence barriers from multiple angles.

Solutions—What can the brand team do about it?

Improve Initial Alignment

An honest assessment of the real patient journey to understand what’s working and where gaps persist is the first step brand teams should undertake to improve alignment. Ensure that the effort is cross-functional and includes clinicians, healthcare economics team members and representatives from both sales and marketing. For example, in a hub model a manufacturer’s representative might know that a prior authorization has not been approved or that a refill has not been picked up. This representative may then go back to the provider to let her know. In this scenario, however, who goes back to the patient for follow up?

Optimize Follow-Up Initiatives

Knowing that half of all new prescriptions don’t get filled, it’s imperative that intensive patient follow up to address concerns, confirm the accuracy of information they have on hand, and reinforce the value of their therapy and compliance take place before patients go to the pharmacy. An assessment of patient needs will generate scores of opportunities for intervention, but the following are high value solutions brand teams can influence for the benefit of patients:

• Patients need constant, regular reminders with good information in the form or format that works best for them: text, phone, email, web, or in person.
• Person-to-person support is the least efficient but most effective. Many manufacturers will not know about prescriptions written or first fills[JC1] . The physician won’t know either. The only people who really know are the patients. If you don’t communicate with patients, it is unlikely you will impact persistence.
• The first refill represents pharma’s top opportunity to influence behavior. This will require time, resources, a new approach to patient engagement, and assumes the manufacturer and brand team actually have enough contact information to reach patients directly. Ultimately, a sliding scale for follow up based on patient needs and preferences is optimal. Patient enrollment program investment is increasing, but what are you going to do with it? Start with intensive engagement efforts— person to person—then scale back as needed. If text reminders are enough, great. If not, persist in your own efforts to reach them in a “whatever it takes to improve patient lives and outcomes” mindset.
• A multi-channel (HCP/DTC), multi-protocol paradigm. While “population health” is a hot term, actual patient health happens one individual at a time. Texting may work for some, but a phone call may be the best fit for others. Certain patients need a text prior to a phone call to trust the intent of the unknown number. And still other patients want to use their new provider portal. A multi-channel, multi-protocol approach drives population health by recognizing and delivering on individual needs. If you don’t have it, you need it. Acknowledge one size does not fit all.

If persistence is the gold standard by which brand teams measure success, investing the right amount of time in the right type of resources is critical.