Getting Adherence On Track
While many critics have frowned upon pharma-driven adherence programs, the drug industry is not about to give up, and some
programs are even achieving accolades.
Case in point: The Fosrenol "On Track" program by Shire, which was established as an addition to an existing patient assistance
program to reach patients with kidney disease that are taking the medication to decrease blood levels of phosphate. Fosrenol
is a phosphate binder that binds with phosphorus and removes it from the gastrointestinal track before it has a chance to
be absorbed into the circulatory system.
The disease has numerous adherence challenges to overcome, most obvious of which is pill burden. Within the first four months
of therapy, the average phosphate binder loses about 80 percent of prescriptions written—which is a significant dropoff over
that timeframe. Another problem is that patients can't normally tell when their phosphorus is high (because they don't feel
anything), yet pills must be taken after every meal. The average dialysis patient is on approximately a dozen different medications,
meaning that cost issues must be taken into account.
"You're going in and getting 12 individual prescriptions filled with 12 different co-pays—that adds up pretty quick, regardless
of if you are a commercial patient, a Part D patient, let alone a dual-eligible patient," says Tim Cox, senior product manager
The program launched in mid-2008 and has been lauded for successfully getting patients to stay on their treatment regimen.
"On Track" includes a co-pay card, a patient assistance program, and relationships with third-party grant organizations to
help patients that are Medicare Part D beneficiaries.
"Education is a critical portion in this disease state," explains Cox. "It's a matrix of individuals treating the patient.
You have social workers, renal care techs, renal dieticians—there are a number of different folks that are influencing the
patient and helping them better understand the disease state, the medication they are taking, and dialysis itself."
The second component of "On Track" is an opt-in adherence program for patients that helps renal nurses communicate with patients
from a call center set up by a third party. There is also a series of five mailers that include details on food choices, information
on how to better utilize support staff to get dialysis, and how to better interact with healthcare professionals.
ADELE GULFO, US President, General Manager, Primary Care, Pfizer
Cox says that Shire tracks the program by tallying the number of drugs sent out through the patient assistance program, as
well as through prescription-level data analyzed through data collection firms, such as IMS Health.
"When we assess our programs, we look closely at co-pay card redemptions as they are used throughout a 12-year period," says
Tanya Kuzminsky, renal dietician. "We've seen uplift in patients remaining on therapy by patients using that card. Similarly,
when you look at the Fosrenol adherence program, we've seen a higher lift in persistency than even the co-pay program."
TIM COX, Senior Product Manager, Fosrenol, Shire
The program provides the educational materials needed for patients to have a robust conversation with their physician so that
the patient will understand what the issues are they are facing and how critical it is to make every dialysis appointment.
"Many of these patients 'crash' into dialysis," Cox says. "They didn't know that they had a problem with their kidneys, until
they are in the emergency room. The next thing they know they are on dialysis and don't understand what happened."
Shire would not share actual numbers before press time, but says there has been a significant uptick in adherence when program
numbers are compared with traditional IMS prescription data.
"For complex disease states, the education is a critical component to be able to get patients up to date on their disease
state and help them better understand the medication that will make them better," Cox says. "The fact of the matter is, once
a healthcare professional trusts us enough to prescribe our medication to a patient, it's our responsibility to provide the
resources and support to make that the most successful engagement that it can be."
TANYA KUZMINSKY, Renal Dietician, Shire