The National Consumers League has joined the adherence bandwagon. In May 2011, the agency launched Script Your Future, a pilot public education campaign in 6 major US markets to raise awareness in patients about the consequences of not taking medication as directed. Recently, the league's polling question invited us to provide our feedback about this question: Why do you think 3 of 4 (75%) of Americans fail to take their medications as directed?
There are 3 answers that consistently rose to top: Patients are unaware of the risks of not following doctor's orders, prescriptions are too expensive to refill, and patients don’t understand dosing instructions.
Many in our industry—most notably the large pharmacy chains—are trying to make it easier on these adherence-elusive consumers:
1. With 1 click on a mobile app, patients can retrieve their pharmacy visit history and refill a prescription; they need to simply scan their prescription’s bar code label with their iPhone or Android.
2. Walgreens is revamping 70 of their locations with in-store clinics to enable easier face-to-face discussions between pharmacists and patients.This type of interaction has been found much more effective in boosting adherence rates than are programs in which pharmacists talk with patients on the telephone.
3. Ninety-day prescription fills are now more commonly offered than they once were, providing patients with opportunities to fill for 3 months at a time, either through their local retail pharmacy or through mail order.
A study conducted by CVS Caremark and Harvard University showed that there is a need and an appeal for each solution, depending on patient type. Some patients stay with mail order, some switch to retail store prescription fulfillment, while others select retail as their pharmacy of choice.
4.Brand Web sites offer interesting adherence and retention tools, such as progress trackers, refill reminders, and co-pay card programs.
While patients can seek out optimal support that keeps them on therapy as long as possible, pharmaceutical companies and pharmacy chains use patient longitudinal data to segment and target their key patient groups, with the same goal in mind. A patient can be a switcher, a new starter, a titrater, and/or a (dis)continuing patient; these are all types of “source of business” variables. These variables help us identify patient groups to communicate with.
For example, chronic patient Mr. Jones who once faithfully refilled his scripts for hypercholesterolemia, suddenly stops going to his local retail pharmacy. The pharmacy, which has business rules in place for the discovery of nonadherent patients, notices that Mr. Jones has not filled his prescription for 75 days. A reminder e-mail is generated and a phone call made. Mr. Jones has now been made aware. The pharmacist can tell him about potential drug-drug interactions and can conduct a comprehensive drug usage review (is Mr. Jones taking more or fewer pills than his doctor has prescribed?). Mr. Jones' out-of-pocket costs can be evaluated and possibly lowered through discount and co-pay assistance programs.
Despite industry’s careful ministrations, adherence challenges remain a top concern for healthcare providers, for commercial health insurance plans, and for Medicare. We are going to need new tools to help us achieve better patient health outcomes and improved adherence—it’s one reason why HealthEd has launched our own HCP-patient communication platform, HealthEd on Demand, and also developed a measurement framework for isolating the impact of patient education on adherence and other core brand objectives. By connecting the dots between patients’ levels of engagement, health beliefs, disease and therapy knowledge, attitudes and (coping) skills with their prescription fill behaviors, we have a better lens on patients’ considerations for staying on or dropping off therapy.
And we create strong opportunities to “bring 'em back to brand.”
Barbara Haimowitz, PhD