ROOTS OF A SOLUTION
From this discussion, what are the optimal best practices that might serve as additional baselines for the NCL campaign?
In addition to MTM, I would emphasize the "strong start" concept combined with efforts to help patients deal with the pill
burden through what is called "refill synchronization." This means that the pharmacist ensures that each of the patients'
prescriptions come due on a single day, on a regular basis. It is a convenience measure that the evidence shows will promote
better adherence. However, there are logistical issues with this approach.
Another innovation is the work that the Pharmacy Quality Alliance is doing to devise a standard metric to identify patient
adherence through the "proportion of days covered" measure. Beginning next year, this metric will be used to evaluate the
success of plans participating in Medicare Part D. Thus, there will be tremendous incentive for health plans to invest in
strategies such as MTM that are proven to improve adherence.
Approximately one-third of US employers have some sort of on-site health facility staffed with a health practitioner. It is
usually not a physician, but the opportunity exists to leverage these sites to build in an adherence agenda. It relates to
my earlier point that the best intervention may not lie with the physician but with others on the health delivery chain. We
could also apply tax credits to encourage on-site health services. That would incentivize more of the large employers to do
this, and eventually that might motivate smaller companies to address it—three-quarters of Americans work in companies with
fewer than 10 employees.
We need to energize the research agenda around adherence. From the payer side, we want to encourage everyone to engage and
initiate good research and to publish the results for all to see.
I advocate looking at adherence as a marathon, not a sprint. Pharma companies often have a short attention span in funding
adherence activities. The ROI calculation has to be framed for the long-term.
With the patent cliff and the increasing demise of the blockbuster drug, adherence should be a strategic priority for Big
Pharma. The economics of the industry is dictating that the balance will need to shift further from patient acquisition towards
patient retention. Adherence education and campaigns are the primary tool to keep the patient on his medications. That simple
message must be delivered at the highest level in pharma so these programs are not relegated to the PR arena. There is no
imminent rational alternative so I expect increased industry spending and prioritization of adherence to be the wave of the
I suggest that adherence activities be incorporated into the templates that result in the content of clinical guidelines,
especially those that can be applied to high-risk populations of patients in the major chronic disease categories.
This group might want to consider a joint endorsement of the work of the Pharmacy Quality Alliance in developing standard
metrics of performance around adherence, and to pledge to apply them in our own organizations.
For the last 40 years we have concentrated on a "one-size-fits-all" strategy to increase adherence. It's time to think differently.
Targeted and tailored interventions are the future; adherence is ripe for the "out of the box" mindset, particularly for the
middle group of patients who begin therapy but then cycle off it at some point. And segmentation should not be limited to
patients. We also have to learn to distinguish between physicians with high-adhering patients and physicians with lower records
of adherence in the people they treat. The point is to learn from those who are successful and apply it to the sub-optimal
performers. Sales reps can be another important resource in promoting adherence. They can educate healthcare providers about
medication adherence as a useful adjunct to providing information on pharmaceutical treatments.
In our campaign we are reaching out to non-traditional stakeholders—the family, the caregiver, the nursing professional, and
even high school students who must know why adherence matters to the longevity of their parents and grandparents. Another
point is the importance of reinforcing the idea that when patients are discharged from hospital, the goal is not to come back,
but to avoid readmission. There is a perfect opportunity at discharge to educate about the use of medications. By improving
patient understanding of the importance of medication adherence at discharge, hospital readmission could be avoided.
These are all useful suggestions. We will all work jointly with NCL to ensure these are incorporated into the blueprint for
the Script Your Future campaign.