Pharma Needs A Medication Adherence Game Plan

By Ken Congdon

Non-adherence to prescription medication regimens has a significant, and well-documented, impact on healthcare. For example, research shows that nearly 50 percent of patients don’t take their medications as prescribed¹ and 1 in 5 new prescriptions go unfilled². As adherence declines, emergency room visits and hospital admissions increase among patients with chronic illnesses — which adds an estimated $100 to $300 billion in avoidable costs to the healthcare system each year. In the end, approximately 125,000 American deaths annually are attributed to poor medication adherence³.

These troubling statistics have prompted many healthcare providers and payers to invest in programs designed to improve medication adherence in their patients. Pharmaceutical manufacturers would be wise to join in this effort — not only for the public good, but because of how improved adherence could benefit drugmakers from a business perspective.

For example, according to a 2012 study by Capgemini, U.S. pharmaceutical companies lose an estimated $188 billion annually in revenue because patients fail to take their medications as directed. Moreover, a decline in adherence often results in a loss of brand equity for the drugmaker. The stakes are indeed high, but luckily, there are several things pharmaceutical manufacturers can do today to help improve adherence rates.

Big Data Provides Pharma With Actionable Medication Information

Tapping into big data is one way pharmaceutical manufacturers can impact medication adherence. Electronic patient data is being captured at every level of the healthcare ecosystem today and pharmaceutical manufacturers can mine and analyze this data to track drug usage patterns and the effectiveness of patient programs. With this information, drugmakers can drive behavioral changes to improve adherence rates, ongoing medication sales, and the overall health of their customers.

In fact, Gary Palgon, VP of Product Management and Strategy at Liaison Technologies, a global integration and data management company, says pharmaceutical companies should become adept at leveraging prescription information from the following five sources to tackle the medication adherence problem.

1. Patient-Generated Data — Patients are more involved in their health and wellness today than ever before. Patients are generating a ton of digital information on their own health habits through use of fitness trackers and mobile health apps. “Pharmaceutical companies that mine and analyze data from these commercial devices can bridge the historical gap that has existed between drugmakers and their end customers, essentially extending their reach and influence directly to patients,” says Palgon.
2. Provider-Generated Data — Pharmaceutical companies have always obtained some level of patient-based prescription data from the physicians that prescribe their products. However, in the days of paper medical charts, this information was fairly inconsistent. With the majority of healthcare providers now entering patient data into an EMR (electronic medical record) and prescribing medications using e-prescribing technology, provider-based data sources are much more robust and accurate.
3. Retail-Generated Data —Retail pharmacies collect a wide range of electronic information on the prescriptions that are filled and dispensed at their locations. This information is also vital to creating a complete picture of a patient’s prescription drug use.
4. Claims Data — “Health insurers have historically kept much of their patient claims data to themselves,” says Palgon. “However, payers are now becoming more engaged in sharing this information with providers in exchange for clinical data. Pharmaceutical companies can gain access to this data as well.” Payer reimbursements for prescription medications are another key data point to determine medication usage patterns.
5. Social Network Data — Today, patients share a ton of health-related insights and concerns on social media networks such as Facebook and Twitter. Apps have already been created (e.g. Sickweather) to mine this public data to determine regional areas affected by outbreaks of illnesses such as the flu, stomach virus, or chickenpox. Patients also share information about the medications they take (e.g. effectiveness, side effects, cost, etc.) on these social networks. Pharmaceutical manufacturers can analyze this data to gain insight into public perceptions of their products.

“By aggregating information from these five data sources, a pharmaceutical manufacturer can see which physicians are prescribing their medications, which retail pharmacies are filling these prescriptions, which insurers are paying the claims, as well as the patient’s own habits and opinions surrounding specific medications,” says Palgon. “When you put it all together, you can get a fairly personalized view of patient medication adherence. You can understand who actually fills their prescriptions in the first place, who refills them, and when they refill them. You can also gain an understanding of why certain patients don’t fill or refill their prescriptions.”

Of course, mining, aggregating, and analyzing all of this data from all of these sources can be difficult for a pharmaceutical manufacturer to accomplish on its own. Most choose to work with data management and patient engagement partners to integrate this data into their internal operations and strategize appropriate actions to improve adherence.

According to recent research, more pharmaceutical manufacturers realize the benefit big data can have on their operations and are making the necessary investments. For instance, a study by benchmarking firm, Best Practices, LLC, shows 30-40 percent of pharmaceutical companies expect their data capabilities to increase over the next two years. Additionally, 40 percent of the study participants said they have a centralized or dedicated big data group.      

Smart Packaging, Pills Promote Adherence

The implementation of smart packaging is another way pharmaceutical manufacturers can help combat the medication adherence epidemic. One such technology is the smart blister pack. This type of packaging contains an embedded microchip that can capture important medicine use data. For example, the packaging can record when a medication is taken or administered, issue a reminder when the next dose is due (e.g. the pack itself can beep or an alert can be pushed to a smartphone), and alert patients when the medication’s expiration date is approaching or the package has been tampered with.

This type of sensor technology is even beginning to extend beyond the packaging and into the pill itself. For example, in July, the FDA expanded the Indications for Use statement for Proteus Digital Health’s Ingestible Sensor technology, enabling the device to be used as an aid in the measurement of medication adherence. Proteus’ edible sensor technology can be attached to individual prescription tablets that communicate with a patch worn on patient torsos to verify when a pill has actually been swallowed. More on this technology can be found in my July 17 article FDA Paves Way For Intelligent Pills.  

Pharma Marketing Should Encourage Persistence, Not Just New Scripts

Another way pharmaceutical companies can potentially have a positive impact on medication adherence is to rethink the way they market their products to health providers and patients. Most pharmaceutical marketing efforts focus on generating new prescriptions and patients rather than ensuring the ones they already have continue to refill their medications. For example, television commercials focus on symptoms and tell patients to “ask their doctors” if a certain medication is right for them. Furthermore, free samples are often used to attract new customers.

What if in conjunction with these new patient initiatives, pharmaceutical companies created marketing programs designed to emphasize the importance of persistent medication use? From a revenue standpoint, it seems like ongoing prescriptions would be every bit as important as sales to new patients. To motivate ongoing medication adherence, manufacturers, in cooperation with retail pharmacies and healthcare providers, could provide discounts on long-term maintenance medications or offer a free one-month supply of a medication for patients that loyally refill that prescription for 11 consecutive months. The idea is to reward patients in such a way that encourages the continued use of a specific medication.

1) Osterberg L, Blaschke T. “Adherence to Medication.” New England Journal of Medicine, Aug 4, 2005

2) Fischer MA, Choudhry NK, et al. “Trouble Getting Started: Predictors of Primary Medication Nonadherence.” American Journal of Medicine, 2011 November

3) McCarthy R, “The price you pay for the drug not taken.” Bus Health, 1998