The New Name of the Game: Adherence

Next time you look at the NRx figures for your drug, consider the following alarming figures: Research shows that one-third of all prescriptions are never filled, and 70 percent of patients who begin a pharmaceutical therapy discontinue it within one year. This includes those with chronic conditions that require ongoing drug treatment to prevent progression of the illness.

Dr. Andrée Bates

On average, patient adherence with medications for chronic conditions is only 50 percent. In some therapeutic areas, levels are even lower: Compliance rates for depression drugs hover between 32 and 40 percent after three months. For antihypertensive and lipid-lowering drugs, the rate is around 30 percent after six months.

Astonishingly, even patients with potentially terminal conditions have adherence problems. Some of the shockers: Oral-formulation chemotherapy drugs (50 percent after four years); drugs to prevent rejection of transplants (48 percent after one year); and HIV (33 percent after one year).

It's been estimated (far too conservatively) that the industry loses $30 billion a year to poor patient adherence.

Those numbers are grim, but here's one that's even grimmer: Few pharma companies allocate more than 3 percent of their marketing budgets to retaining patients. In today's tough pharma market, throwing money at potential new customers rather than investing in the customers one already has is like pouring sand into a bucket with a hole in the bottom.

Isn't it time to start building a compliance strategy into your DTC advertising?

A Problem with Many Causes

From 1997 to 2003, traditional DTC advertising successfully increased the number of patients who specifically asked their doctors for a brand-name drug. Now, however, that steady increase has reached a plateau and has even begun to decrease. This represents a significant loss for pharmaceutical companies that have spent millions of marketing dollars to get those initial prescriptions. One obvious way to rebuild the value of advertising is to start to focus on current and former patients.

More About Adherence from This Author

But how? It's clear that nonadherence is a complex problem with a variety of potential solutions. And, unfortunately, the answer isn't as easy as rolling out a DTC print campaign simply urging patients to take their medication. Brand marketers must evaluate the underlying causes for noncompliance for their brand, as well as the bottom-line return on investment for specific compliance activities. Otherwise, their efforts may well be doomed to failure.

One study showed that there are about 250 factors that contribute to patient nonadherence. Generally, however, we can break them down into four main categories:

Product attributes These include the drug's efficacy, side effects, dosing, and ease of administration. One study of Medicare beneficiaries found that 27 percent of seniors who skipped doses or stopped taking a medicine because of side effects or poor perceived efficacy did not tell their physician. The opposite is also true: Studies find that patients who perceive greater benefits from a drug, and a greater importance in taking the drug, tend to be more adherent.

Moderating factors This list includes the cost of the drug, physician communication about its use, and patient ability to fill the prescription.

Unintentional nonadherence This includes when patients just forget to take their medication, or go on a trip and forget to bring it with them.

Emotional factors These come into play in a variety of situations, such as when the patient feels better and stops taking the medication; decides to try nondrug alternatives; or, as is common with conditions like hyperlipidemia or hypertension, is asymptomatic and doesn't understand the need for the medication.

The specific causes for noncompliance differ from one therapeutic area to another and from one drug to another. If a pharmaceutical company is to really improve patient compliance and optimize the revenue from a drug, it needs to understand the specific causes of patient noncompliance for its therapy area and specific drug.

The Adherence Toolkit

Obviously, there can be no single panacea for poor adherence. Many approaches to increasing adherence are available. Besides DTC advertising, these include patient education, cost-related approaches, packaging, delivery options and dosing regimens, call center support, Short Messaging Services (SMS), electronic medical records programs, pharmacy interventions, patient-assistance programs, drug-discount and loyalty-card programs, patient-experience programs, involving family members, and training physicians.

Unfortunately, even the best-intentioned patient adherence program is doomed to fail unless pharmaceutical organizations:

• Evaluate underlying specific causes for noncompliance with their brand to guide the program's implementation
• Address barriers to implementation
• Understand the bottom-line return for specific compliance activities.

Adherence to prescribed medications, particularly for long-term therapies, poses a tremendous challenge to the world's pharmaceutical companies. Investigating and understanding the underlying brand-specific reasons for lack of compliance, and developing and implementing adherence-specific DTC and other programs, can help brand managers increase market share and revenues for their brands while significantly improving clinical outcomes for patients.

Dr. Andrée Bates is an author and thought leader in the marketing ROI arena. She can be reached at abates@eularis.com