The average drug loses 36 percent of its sales a year due to poor adherence. And one-third of prescriptions are never even filled. As riveting as these numbers are, they are no surprise to anyone in pharma.

Despite efforts to reach out to patients and physicians through new technologies, increased online information, and adherence-driven DTC advertising, the industry has yet to develop and execute an effective adherence strategy.

There are many reasons why individual patients do not adhere to doctors’ orders—including cost, fear of side effects, and lack of belief in the need for the medication or its effectiveness.
Studies show that 20 percent of patients will be non-adherent no matter what a physician or pharmaceutical company does, and 20 percent of patients will always dutifully follow their doctors’ orders. That means an opportunity exists to reach out to the remaining 60 percent of patients who can be influenced.

To be effective, an adherence strategy must be responsive to an array of patients with different habits and medications, while providing information, encouragement, and support until adherence becomes reliable. It must focus on the needs of specific patient segments and even specific pharmaceutical brands in addition to adjusting for the disease state (for example, breast cancer) or broad therapeutic area (for example, oncology). It also should include three key elements—education, motivation, and monitoring. (Most plans use one or two, but not all three.)

The bottom line: An effective plan is one that allows a physician to help a patient adhere to the medication. It further enables a physician to know and to understand the challenges his or her patient faces. Then and only then can something be done.

Patient-Physician Communications 
One path to understanding what a patient is going through is simply to ask:  What do you feel about your current medication experience?  This can be done in depth by giving the patient a questionnaire prepared by a third party at the behest of the brand’s company. After processing the patient data, it is shared with the doctor. The information covers the patient’s current experiences (as well as his or her past adherence behaviors). The physician can then assess the information and address the patient’s concerns. If there are problems, the questionnaire data will help the physician to quickly address them. And even if there are no problems, it gives the physician a way to predict and to influence future adherence issues the patient might experience.

Patient Feedback Marketing
Each program originates with the sales rep who recruits the physician. The physician then invites the patient to participate. The patient enrolls and provides baseline information. As the cycle progresses, the patient continues to communicate, via questionnaires, his or her experience with the brand, which in turn is processed and fed back to the brand team, which supplies them with consumer data and insight into brand performance. The physician also receives individualized patient feedback reports. And, ideally, by way of this back and forth, the patient and the physician establish a more effective communication.

Strategic benefits
The frequency of the collection and dissemination of information should be shaped by the treatment and the specific brand of medication. For instance, if there is a known point of adherence drop-off for a particular medication—a point at which a patient may experience unpleasant side effects—the strategy can take this into account and address patient concerns prior to that point.

A pharma company also can use the ongoing communications with  patients to identify new educational opportunities and to share that information with prescribing physicians.

Motivation and monitoring
This give-and-take of information between pharma companies, physicians, and patients can have the desired effect of making patients feel like active participants in their treatment. It can also enhance their feelings of trust and responsibility.

Having patient treatment monitored, providing information, and having it returned to physicians who then review and discuss it with their patients can be an incentive for patients to make a commitment to a therapy, and adhere to  physician requests.

From a physician’s perspective
Similarly, the regular collection of patient feedback can help physicians be more informed and engaged in their patients’ care, as well as helping patients to adhere to their prescribed treatment regimens. The result: an increased number of positive treatment outcomes.

Additionally, the collected data gives physicians valuable information and insight into patient experiences with brand-specific drugs. This can increase the likelihood of those physicians prescribing the medications again.

Improving adherence extends beyond stemming the flow of lost pharma revenue. Individuals who are not compliant with prescribed medication regimens are estimated to cost the United States between $13 billion and $15 billion annually (Mistry & Sorrentino, 1999). The hope is with healthier, more adherent patients who are more involved in their care, those costs will dwindle, as will the costs that are handed down to the consumer. Adherence then becomes a win-win situation for many.

Side Bar: How it works
A pharma-sponsored patient feedback adherence program was implemented to supplement the education patients receive at a physician’s office about cholesterol management and the role of a particular medication. It included questions and feedback geared specifically toward increasing adherence to the medication, diet, and exercise.

Designed by InfoMedics in 2006, the survey included 6,800 patients who were asked about their understanding of the condition, and of the prescribed medication. They also were asked about compliance, satisfaction, and their intent to continue the medication. Their prescribing physicians received feedback reports summarizing patients’ responses.

Independent analyses conducted by IMS Health revealed participants in the program increased their adherence to the medication by 17 to 27 percent, relative to similar patients who did not participate in the program, depending on where they were in their treatment. The smallest difference (17 percent) was observed among patients filling their first prescription. The largest (27 percent) was observed among those filling six or more prescriptions. A new prescription increase of 17 percent was seen among physicians with participating patients, and an estimated $7.4 million in incremental revenue generated by participating physicians

Stanley Wulf, MD, currently serves as the vice president and chief medical officer of InfoMedics, Inc.