But how to get that commitment? According to IMS Health, five common themes emerge when patients are asked why they discontinued a medication or failed to comply:
» Unconvinced of the need for therapy
» Unconvinced of the effectiveness of the medication
» Side effects of the medication
» Difficulty with administration
» Out-of-pocket cost

Pfizer recently created a disease management program for patients with chronic conditions. The target audience was Medicare patients—arguably the poorest, least educated, least motivated patients.

"It took an unconventional approach to show them they needed to be more committed, rather than tell them that they needed to comply," Devlin says. "We sent nurses into the community to speak to them in their own language. We created educational material in Haitian and Creole and different dialects of Spanish. Patients were taken aback that these people spoke to them, that they came back a second time. That was the key: showing them that we were committed to them and they weren't just going to get a brochure."

"Some conditions are acute and people want to know everything about it," says Mark Klapper, vice president of strategic planning at Micromass Communications. "For asymptomatic conditions like hypertension, part of the challenge is convincing people that they need to pay attention. You are going seeing a lot of DTC messaging extended to the compliance area."

A Patient Ally

One place pharma is turning for inspiration is the over-the-counter world. One of the most talked-about OTC patient programs is the My Alli plan for GlaxoSmithKline's weight loss drug.

"When you're dealing with wanting to lose weight, it is about modifying behavior," says Karen Scollick, GSK's vice president of behavioral sciences. "Behavioral support tools are an important part of how the program works."

Included in the Alli starter pack is a comprehensive introductory print piece with a code that allows the user to register online. The 12-month program includes dietary information, a food journal, eating programs, and tools to monitor weight loss.

Additionally, GSK just launched the Alli Circles, a program run through the product's Web site that focuses on real success stories from users. "The word-of-mouth facilitation is very important," Scollick says. "We have a message board facility online where individuals can talk about their treatment. We don't get overly involved on the board. The stories are real testimonies, so we just use moderators to make sure there is authenticity and integrity."

Is the program working? Of the 4 million Alli users in the world, 375,000—more than 10 percent of unique starters—have enrolled. That might sound low, but considering that less than five percent of prescription drug users enroll in compliance programs, 10 percent isn't bad.

Scollick says GSK is interested in adapting some of these tools to prescription drugs. "We are open to new ideas and new technologies to enable to us to communicate better with our consumers," he says. "The end-users have an insatiable thirst for education and information, so any technology that can enable that is worth considering."

Alli was one of the first drugs approved by FDA as both a pill and a program, and some experts think this is going to be a trend. "You're seeing FDA look at categories where behavioral change is necessary to go beyond the benefits of the bottle," says Link.