Hard of (Ad)hering - Pharmaceutical Executive


Hard of (Ad)hering

Pharmaceutical Executive

When your biggest products are going off patent, your biggest customers are pushing back hard on prices, and you don't have enough new products in the pipeline to make up the shortfall, what do you do?

There's more than one answer to that question—the key question facing pharma these days—but certainly one classic answer is: sell more to your existing customers.

At first blush, that's a solution that makes no sense for pharma. Patients get sick only so often, prescriptions cap utilization, and there are relatively few conditions for which add-on therapy—even when justified—can benefit the maker of the original therapy.

Of course, that assumes that patients actually take their medications, and there is ample evidence that they don't. Surveys have revealed that:
Fifty percent of patients forget to take their meds and over 30 percent don't refill their drugs
Twenty percent say they don't take the full course of treatment
Fifty percent of patients don't take drugs as directed

This massive breakdown of adherence and compliance has big impacts for both patients and pharma. It's been estimated that as many as half of all prescriptions fail to have the proper effect because of failures to take the drug or to follow instructions. And according to IMS, compliance issues cause the industry to lose $177 billion a year—a remarkable figure in a $700 billion a year industry, and one that still may actually underreport the effect of noncompliance.

These are patients who have already been diagnosed and prescribed. The question for pharma is how to keep them on therapy and taking their medication correctly—for their sake and the sake of the business.

"We're looking at a third of prescriptions not being filled at all, and an average of 50 percent non-compliance for chronic ailments," says Stanley Wulf, vice president and CMO at Infomedics. "The focus hasn't been on [adherence] because there has been enough activity in the drug pipeline to fill the cup consistently—disregarding the fact that there are holes in the cup."

Pharma is now implementing new technologies and programs—both high tech and old school—to help patients adhere to their drug regimens and to recover the money that it has been hemorrhaging in lost prescriptions. Tools such as reminder messaging, nurse services, and disease-state compliance programs are at the top of pharma's list of compliance tricks. And while many of these tools are still unproven, the fact remains—pharma is trying.

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"One challenge," says Ian Wolfman, senior vice president of IMC2 , "Is that not all products—and not all disease states—are created equal."

At one end of the spectrum are products for chronic, asymptomatic conditions such as high blood pressure or elevated cholesterol. They're low-priced and widely distributed. Their compliance challenge is that benefits aren't apparent day-to-day.

It's at the other end of the spectrum that pharma has seen success, in disease states that have specialty-distributed products (such as human growth hormones)—high-price, high-value drugs that have a big impact.

Years ago, for example, Serono decided to boost compliance of its HGH product Saizen, which features a needle-free device geared toward younger patients. This was a small segment comprising thousands of patients, but Serono realized that there was a huge benefit in getting the patients to stay on the product and take it properly.


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