The road map on medicines adherence—once a straight line to a certain destination called prescription non-compliance—is starting to set some potentially exhilarating new curves. A rush of advanced, personalized technology applications; new legislated requirements under US health reform, accompanied by more public funding for patient-centered behavioral research; and heightened interest in the clinical benefits and cost savings from adherence particularly among pharmacists, payers, and employers—are each adding a flash of fresh chrome to the decades of effort to build a better model for getting patients to take their medicines.
The statistical case for medicines adherence is more compelling than ever, particularly as healthcare costs consume more and more of US economic output. Today's metric of choice is $290 billion, which the New England Healthcare Institute says is the "otherwise avoidable medical spending" caused each year by patients not taking a prescribed medication. Last November, the full weight of the federal government was brought to bear on the issue, in a Congressional Budget Office (CBO) report demonstrating that, when patients fill their prescriptions and take their medications for the duration of treatment, it lowers emergency care and hospitalization costs for Medicare by an estimated two-tenths of one percent a year.
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Industry was quick to notice, with PhRMA President John Castellani lauding the report as "a sea change in government thinking," helping to tag adherence as a national priority. Such a designation can come none too soon for Big Pharma, which, according to data from the consultancy Capgemini, ceded $188 billion in potential 2011 profits in the United States alone from poor rates of medication compliance among patients taking their drugs.
Mandate for change?
Yet the industry faces a larger dilemma. Legal and regulatory barriers—including mounting privacy concerns—are putting the brakes on more creative solutions to adherence being considered by drug makers. Other sectors of the healthcare business face fewer constraints; they are progressing faster in developing agile strategies that meld adherence programs to their basic commercial model. "Big Pharma risks becoming the bench warmer on adherence due to the need to play it safe in that regulatory gray zone on what constitutes impartial information versus a promotional inducement or message beyond a label's stated indication," says Rob Nauman, principal of BioPharma Advisers. He notes that drug makers are unique in having to struggle with the reputational yellow card that comes with increased adverse events reporting, which is often inevitable when there are a lot of two-way, multi-channel initiatives, all ostensibly designed to track patient compliance with therapy.
Nauman's message underscores that to prevail, drug companies must think more strategically about their overall patient engagement tactics. The key is to develop scalable, "win-win" campaigns—campaigns that consist of content people want to consume, help support and enhance brands' market position, offer attractive value propositions to providers, and deliver a measurable ROI by helping the patient to be compliant through the full course of treatment.