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How can pharma companies tackle therapy nonadherence to improve health outcomes?
Therapy nonadherence is a vital issue that contributes to poor clinical outcomes among patients with chronic illnesses. In the United States alone, nonadherence contributes to up to 50% of treatment failures, and around 125,000 deaths each year. Despite the evolved understanding regarding the magnitude and repercussions associated with therapy nonadherence, pharma companies have not been successful in their attempts to control or eliminate it.
In this white paper, we explore how pharma companies can overcome therapy nonadherence among patients by:
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Personalizing solutions through artificial intelligence (AI) and data-driven modeling
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Working collaboratively with different influencers in the healthcare ecosystem
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Improving patient experience
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Using the power of data to measure adherence and fine-tune programs
Rick just received his blood reports, and they do not look good – his sugar levels are unchanged since his last visit to the physician. Rick suffers from secondary diabetes – a chronic condition that requires a long-term use of medications to control his sugar levels. He has a follow-up appointment with his physician to discuss his results today. But Rick is facing a dilemma as he has not been taking his medications regularly and is reluctant to share this with his physician. Unaware of Rick‘s fallacious behavior, the physician is now likely to change the course of the treatment and this may have a negative impact on Rick‘s health.
Unfortunately, Rick is not the only one who faces such a conundrum when visiting their physician. Research shows that a staggering 50% of patients suffering from chronic illnesses do not take their medications as per the physician‘s recommendations (1). Moreover, not adhering to the physician‘s instructions is not a modern-day issue. The first mention of therapy nonadherence can be traced back to 400 BC when Hippocrates first noted that some patients tended to lie about taking their medications correctly and then complained about the consequences (2).
Therapy nonadherence has profound implications
Therapy adherence refers to the extent to which a patient‘s behavior conforms to the recommendations made by the treating physician concerning the timing, dosage, and frequency of the treatment. It is often used synonymously with therapy compliance. However, compliance refers to a patient‘s passive behavior to follow their doctor‘s orders, whereas adherence assumes the agreement of the patient with the recommendations made by the physician.
Here are some numbers that show the extent and the impact of issue:
In the United States, nonadherence can account for the following each year (1):
of treatment failures
deaths
of hospitalizations
Apart from poor patient outcomes, therapy nonadherence also affects physicians, healthcare systems, and pharma companies in various measures and magnitudes. Every year, pharma companies lose billions of dollars due to nonadherence to medications for chronic illnesses. Moreover, nonadherence creates a perception of treatment inefficacy among patients. This inaccurate assumption reduces pharma‘s brand equity, customer retention rates, and profit margins.
Despite this evolved understanding regarding its magnitude, nonadherence has not received the attention it deserves. In this white paper, we delve deeper into the issue to provide some innovative recommendations to control nonadherent behavior among patients.
Why have pharma’s adherence-promoting interventions failed to hit the mark?
Traditionally, patients have been solely held responsible for taking their medications. Healthcare systems and pharma companies have heavily relied on physicians to warn patients about the ill effects of not taking their medications on time. However, the growing understanding regarding the range of factors that can lead to nonadherent behavior among patients has forced pharma companies to come up with several innovative interventions. Some of these include financial schemes or discounts to improve drug affordability, telephone or email reminders to enhance persistent behavior, and nurse- or pharmacist-driven education programs to ameliorate awareness about diseases and treatments.
So, why have these interventions proven ineffective? That is because patients switch between active and passive modes of nonadherence as they go through their health journeys. A limited understanding of various barriers faced by patients suffering from the same disease at different stages in their treatment has led pharma companies to adopt a one-size-fits-all approach for their adherence programs. Furthermore, siloed program operations, a lack of data-driven insights to optimize and improve program performance, and a myopic mindset toward future innovations have led to a limited return on investment (ROI) from pharma’s current adherence-promoting initiatives.
So, how can pharma companies overcome therapy nonadherence?
Here are some innovative strategies that pharma companies can adopt to tackle therapy nonadherence among patients.
Personalize solutions through AI and data-driven modeling
Initiation, persistency, following a healthy lifestyle, monitoring food intake, remaining self-motivated, and having the right attitude, cumulatively contribute to adherent behavior in every individual. However, the magnitude of the impact of each of these individual parameters differs from patient to patient. Therefore, pharma‘s one-size-fits-all approach was always doomed to fail.
Personalization is key while creating customized care plans that help drive adherent behavior among individual patients. Here is a 3-tier approach driven by AI and data-driven modeling that can help deliver true personalization for every patient.
1. Segmentation
This involves identifying key therapy- and disease-related barriers faced by patients to define primary personas.
2. Risk stratification
This step classifies the personas into low- and high-risk groups based on socioeconomic- and lifestyle-related factors that can result in nonadherent behavior among patients.
3. Behavioral modeling
A patient‘s behavioral insufficiencies can negatively impact their ability to remain adherent. By closely working with counselors and social workers, pharma companies can identify behavioral patterns that confound a patient‘s attitude toward their medications and apply these insights to further clarify the personas.
Personalization goes over and beyond ‘the right content at the right time via the right channel‘ approach. Pharma companies need to find innovative ways to map customized care plans and personalized service models to every patient‘s unique needs and challenges.
Manish Gupta
Chairman and Chief Executive Officer
Combining this 3-step framework with relevant solutions and a performance measurement loop can help pharma companies improve the impact of their adherence programs and enhance patient satisfaction.
Collaborate with different influencers in the healthcare ecosystem
The responsibility to remain adherent does not solely lie with the patient. Influencers such as caregivers, physicians, nurse practitioners, payers and pharmacists have a profound effect on patient behavior and their attitude toward treatments. Here are some initiatives wherein pharma companies can work collaboratively with these influencers.
Physicians
Nonadherence is a serious concern for physicians. By partnering with them on adherence programs, involving them through virtual care, sharing performance data with them on a timely basis, and incorporating their inputs into programs, pharma companies can reduce patient drop-off rates at the key leakage points in their treatment journeys. Additionally, a recent study also demonstrated that medication regimen complexity led to therapy nonadherence among patients with hypertension (3). By educating physicians about novel, and innovative dosage forms, pharma companies can alleviate the nonadherent behavior of the patients due to treatment complexity.
Pharmacists
Prior studies have demonstrated that pharmacist-led interventions can enhance therapy adherence and improve treatment outcomes (4)(5).
Pharmacists can no longer be seen as ‘supporting actors‘ who stand behind the desk, dispensing drugs. For many patient demographics, smart messaging delivered by the pharmacist can play a critical role in the success of adherence programs.
Furthermore, new models such as Direct to Pharmacy (DTP) have also been successful for many chronic therapeutic areas due to reduced drop-off and higher refill rates. Moreover, driving HCP engagement through electronic health records (EHR) can help improve therapy adherence via the DTP model.
Nurse practitioners
Very often, time constraints and bandwidth issues can limit the interactions between physicians and patients. By collaborating with nurses and nurse practitioners to counsel, educate, and reassure patients, pharma companies can overcome several drivers leading to intentional nonadherence. Some of these drivers include the lack of information about the disease and treatment, fear of side effects or dependence, and confusion surrounding complex treatment regimens.
Caregivers
Caregivers play a major role in defining a patient‘s willingness to take their medications on time. Organizing workshops or webinars that educate caregivers regarding the long-term benefits of following the physician‘s instructions can positively influence treatment adherence among patients.
Payers
The high cost associated with treatments is a major driver of primary nonadherence. A recent study demonstrated that the prevalence of cost-related nonadherence to prescription medicines among all older adults accounted for 16.8% of cases in the United States (6). By working collaboratively with payers to come up with innovative solutions, pharma companies can help patients overcome the financial barriers to treatment nonadherence.
Improve patient experience
The overarching goal of pharma companies is to enrich the lives of patients and improve health outcomes. Yet, most of pharma‘s capabilities, processes, and investments focus on honing engagements with physicians. In order to engage with today‘s modern and knowledgeable patients, pharma companies need to adopt patient-centricity in a scalable and efficient manner. They need to rethink their business models, metamorphose their commercial strategies, and begin designing solutions and services around the patient. By understanding patients‘ issues, increasing touchpoints, personalizing interactions, and ensuring that empathy exists at the heart of all their initiatives, pharma companies can build resilient relationships with patients that drive adherent behavior and improve health outcomes.
Use the power of data to measure adherence and fine-tune programs
As pharma companies gear up to introduce novel patient support programs (PSPs) to promote adherence, they also need to build capabilities to measure and optimize their performance. Identifying relevant methods to collect data, converting this data into strategic insights, building agile capabilities to execute them, and repeating this process regularly, can help pharma companies derive better returns from their adherence-promoting initiatives. There are several direct or indirect methods of collecting data, and they have their own merits and demerits. Some of these are mentioned in the table below (7).
Sources of data
Direct method
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Measurement of drug/metabolite levels
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Electronic databases
Indirect method
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Self-reported (questionnaires and visual analog scales)
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Electronic monitoring systems
As far as performance measurement is concerned, key performance indicators (KPIs) such as program utilization, initiation, persistence, length of stay, dropout rates, and customer satisfaction scores can help determine the success of an adherence program. Depending on the nature of the program, pharma companies can also define some additional metrics to measure the performance of their tele-support, financial- and pharmacist-driven initiatives. Regardless of the measurement framework defined, it is necessary to share timely progress reports with the key stakeholders, including physicians and payers, to ensure their continued support of the program.
Three core principles to prioritize while designing an adherence program
Behavioral science explains how people can be irrational and reveals how to utilize their shortcomings to help them. Behavioral science has proven effective in delivering impactful interventions for behavioral change, driving patients to take charge of their health. Here are three behavioral science-based strategies that can enhance the pharma‘s ROI and improve health outcomes when combined effectively with any PSP.
Behavioral and motivational support
This involves helping patients understand the relationship between thoughts, feelings, and actions, enabling them to recognize decision points, cope better with emotions, and improve daily planning and routines. It also entails adopting a patient-centered, collaborative approach to elicit and strengthen their potential to change through motivational interviewing.
Educational support
This involves delivering information at key inflection points, verifying if it was processed, and ensuring its direct relevance to nuanced personal experiences.
Self-management support
Personalized support to ensure self-management of treatment is an effective strategy to address challenges in medication-taking, empowering patients to take care of themselves. By increasing the patient‘s ability to self-manage their treatment, inculcating self-dependency, and driving proactive healthy behavior, pharma companies can enhance medication adherence and maximize the efficacy of treatments.
The time to act is now!
Generally, adherence rates of ≥80% are necessary to achieve the optimal therapeutic efficacy of any medication (2). However, with adherence to chronic medications being around 50%, pharma companies need to tackle this issue with a sense of urgency (8).
By adopting some of the strategies provided in this white paper, building agile organizations, and implementing relevant data-driven technologies, pharma companies can not only save more than US$600 billion per year (9) but also help patients like Rick achieve better health outcomes.
Case study
A leading pharma company drives better patient adherence through its multidimensional PSP
A global pharma company wanted to design and operationalize innovative PSPs to improve medicine access and adherence among patients suffering from conditions such as heart failure, cancer, and retinal disorders. However, delivering a multipronged PSP across therapeutic areas was challenging.
With Indegene‘s comprehensive patient support capabilities, the company was able to deliver a successful multi-dimensional PSP.
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Indegene organized awareness clinics and webinars to improve therapy awareness among patients and caregivers.
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It instituted tele- and in-person counseling services and devised a mobile app to improve symptom monitoring and boost therapy adherence.
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Indegene also collaborated with private financing institutions and government funding bodies to formulate innovative financial schemes and reimbursement systems that enhanced treatment affordability.
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Finally, it onboarded online pharmacies to create an order management system to ensure easy medicine procurement and delivery.
Indegene designed and administered 19 PSPs across 32 medicine brands and 12 therapeutic areas to deliver impact to patients, spread across 6000+ hospitals/clinics. As a result, the company was able to achieve the following:
Patient enrollments
Therapy adherence in 10 months
Repurchase rate across 32 medicine brands
References
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Wakai E, Ikemura K, Kato C, Okuda M. Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension. PLoS One. 2021 Jun 10;16(6):e0252944. doi: 10.1371/journal. pone.0252944. PMID: 34111189; PMCID: PMC8191947
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HealthPrize, Capgemini. Estimated Annual Pharmaceutical Revenue Loss Due To Medication Non-Adherence.; 2022. Accessed July 5, 2022. https://capgemini.com/wp-content/uploads/2017/07/Estimated_Annual_Pharmaceutical_Revenue_Loss_Due_to_Medication_Non-Adherence.pdf
Authors
Nitin Raizada
Arindam De
Durgagauri Sabnis, PhD