A more personalized approach to compliance

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker. Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization. Is this the answer and what is pharma’s role in compliance ?

The pharma industry doesn’t, for the most part, take non-compliance seriously. I can say first hand that most business plans for new drugs take into account non-compliance and very few pharma companies have been successful in getting patients to stay compliant. Even researchers from Belgium reported that the compliance rate for Gleevec patients with newly diagnosed chronic myeloid leukemia (CML) is much less than expected.

The reasons for non-compliance are varied but the three biggest reasons seem to be concerns over safety, cost and patient behavior. As patients take exert more control over their health care they are learning that even medications that have been on the market for a long time may not be safe. During a recent national news report a leading physician said in an interview “people should take the smallest dose of medication possible for the shortest period of time possible”. Not exactly a good way to ensure compliance.

The pharma industry has to be very careful about programs that reward compliance because the media probably would see this as a way to keep sales growing. However fear should not prevent them from working with insurers and HCP’s to raise the rates of compliance thus lowering overall healthcare costs. There is no quick solution to increase segmentation it’s going to take a shift in marketing thinking from mass marketing mentality to a more personalized approach.

I believe that the first step in tackling the compliance challenge is to define the seriousness of non-compliance for each drug. Non-compliance for some drugs could be life threatening while others non-compliance may not be so serious. This means that drug companies need to provide good sound hard clinical data to insurers supporting compliance vs. non-compliance and this data has to be in the terms of cost to the insurer.

Once a drug is classified as compliant essential the next step in my opinion is to lay the foundation for compliance programs. Frankly the insurer knows if patients have filled their Rx and are renewing their Rx’s and as thus they could incite patients to become compliant by offering rebates in lower premiums coupled with financial incentives to lead a more healthy life (i.e. lose weight). Insurers could also, for example, require that customers log onto their insurance portal site where they could receive messages and reminders about renewal of Rx’s.

I’m not sure that email or mobile reminders would be that effective with patients. When I was marketing diabetes products we learned that patients did not want to receive emails reminders because it reminded them that they had diabetes and they didn’t like it. However, some caregivers loved the idea of mobile reminders especially for juvenile diabetes patients. One area that worked very well was the ability to download Outlook (the most widely used email program) reminders that allowed patients to set how and when they would be notified. There was also a big difference in attitude between Type 1 and Type 2 diabetics. Newly diagnosed Type 1 diabetics were still dealing with the fact that although they were healthy they had diabetes. There is a perception in our communities that people who have diabetes are in poor health and Type 1 diabetics did not like to be reminded that they were dependent on insulin.

No one solution is going to work to increase compliance among patients. It is going to take a major shift in thinking along with a more personalized approach to medicine, which is really needed today anyway. HCP’s are quickly becoming overwhelmed with information and a transformation to the online world for medical records and paperwork. Unless there is a tool that they can use to help their patients become more compliant I doubt that they would use it although the insurance companies could surely find ways to compensate physicians for having their patients become more compliant.

As long as continued pressure is brought on our healthcare system to reduce costs eventually more attention is going to have to paid to the issue of compliance purely as a cost savings program.