What is the most dangerous drug on the market? For many patients, it's the drug they take incorrectly or fail to take at all.
Patient persistence and compliance, though they rarely make it to the front pages of newspapers, are an immense public health
problem, as well as an ongoing business problem for pharma. Companies have recently been exploring ways to enhance compliance,
working through doctors, Web sites, and other direct-to-patient communications. But they often neglect one key tool for compliance:
the pharmacist. New research, involving both surveys of pharmacists and "mystery shoppers," shows what's happening and not
happening at the drugstore counter, and suggests some ways companies can make use of a neglected resource.
Clinical studies suggest that, in general, only half of all patients who are instructed to take a prescription drug still
take it one year later, and as many as one-third of all prescriptions are never refilled.
The cost of this sort of noncompliance is staggering. Studies estimate that noncompliance causes 125,000 deaths and more than
$100 billion in increased healthcare expenses and productivity losses. Beyond that, pharmaceutical manufacturers lose about
$15 billion to $20 billion annually in future sales from brand switching and negative word-of-mouth caused by perceived product
failure—which happened because the patient didn't take the medication as directed.
The reasons are as varied and personal as the individual. For some, the cost of the medication is prohibitive. Patients split
pills, take them irregularly, or just don't refill the prescription. For others, the unpleasant side effects aren't worth
the benefits. Or, patients may not perceive any benefits for symptomless conditions such as high cholesterol or high blood
But alongside those personal reasons, there is a breakdown at the pharmacy counter. According to a survey we conducted of
5,952 panelists, only 21 percent of pharmacists discussed with respondents potential side effects when they filled a new prescription.
The survey also showed only one-third of pharmacists stressed the importance to patients of taking the prescription as directed,
for the full duration, or whether or not they felt better or experienced side effects.
Meanwhile, less than 20 percent of those surveyed said someone from the pharmacy contacted them after the prescription was
filled, and about the same number of respondents said their pharmacy notifies them when a prescription needs to be refilled.
One important tool for exploring the interactions that take place at the point of purchase is the use of mystery shoppers—trained
auditors who anonymously evaluate customer service, operations, employee integrity, merchandising, product quality, and other
factors. For many years, the retail and restaurant industries have employed mystery shoppers to collect unbiased, third-party
information about their stores and their sales associates. Pharma companies can apply the same strategies to better understand
patient–pharmacist relationships that may influence compliance.
Most Frequently Asked Questions
The opportunities are abundant. More than 130,000 retail pharmacists work in 55,200 retail pharmacies nationwide. Mystery-shopping
programs can provide insight and data to pharma companies on a wide range of possibilities for noncompliance, including pharmacist
conversations and recommendations on particular medications. Ultimately, the information can uncover potential areas for pharma
companies to direct their outreach and educational efforts.
In spring 2006, Corporate Research International sent 520 trained undercover auditors, all with diabetes, into pharmacies
nationwide to collect information on pharmacist recommendations for glucometers and other diabetic needs.
When asked to recommend a glucometer, six percent of the pharmacists preferred the generic brand; the balance was split about
equally between Accu-Check, One Touch, and other miscellaneous products. Ease-of-use was the number-one reason pharmacists
suggested one brand over another.