PharmacyFirst Plan

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Patient Compliance, Adherence, and Persistence
Tim R. Garde Managing Partner The Star
Group May 20, 2008
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//Definitions

• Patient Compliance general term for the extent
  to which patients follow their physicians
  directions with medications
• Adherence used to define appropriateness of
  use, typically calculated as a proportion of
  prescribed doses that are actually taken as
  prescribed (i.e., a fraction)
• Persistence a measure of duration, in terms of
  days, months, or years
• Patient Compliance, Adherence,
  and Persistence

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//Target Audiences

• Patientsimproving health and quality of life
• Caregivers
• Health Care Providers Physicians and
  Pharmacists
• Payors
• Healthcare System
• Patient Compliance, Adherence,
  and Persistence

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//The Facts

• 60 of physician visits result in a pharmacy
  prescription
• 50 of patients fail to have initial
  prescriptions filled
• 20 of patients comply
• 30 of patients fail to refill their
  prescriptions
• 30-50 decline after 1st or 2nd refill
• Patient Compliance, Adherence,
  and Persistence
• Various Commercially Available Sources, 2007-2008

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//The Facts

• Low adherence can cost an extra 2,000 a year per
  patient in extra physician visits alone
• 177 billion in medical bills and lost
  productivity due t poor medication adherence
• The poor are the least compliantthe healthiest
  are the most compliant
• Patient
  Compliance, Adherence, and Persistence
• Various Commercially Available Sources,
  2007-2008

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//Rates and Possible Consequencesof
Non-Adherence

• Condition Non-Adherence Rate Consequence
• Epilepsy 30-50 Relapse
• Arthritis 55-70 Pain
• Hypertension 40 Hospitalization
• Diabetes 40-50 Loss of Control
• Asthma 20 In-patient Visits
• Alcoholism 48-56 Relapse
• Anticoagulants 30 Bleeding
• Estrogen RT 57 Osteoporosis
• Patient Compliance,
  Adherence, and Persistence
• Source GlaxoSmithKline 2008

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//Why Patients Do Not Comply

• Forget
• Do not understand or misinterpret instructions
• Obstacles (i.e., difficulty in swallowing,
  opening bottle)
• Adverse side effects / lack of understanding or
  confidence in drug safety
• Cost / lack of insurance coverage
• Patient Compliance,
  Adherence, and Persistence
• Source Alliance Healthcare Information, Inc.,
  2008

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//Why Patients Do Not Comply

• Feel better
• Deny illness
• Do not believe drug will help
• Do not care about getting better
• Worry about becoming resistant to the drug or
  think the dug is not working because they do not
  feel different
• Patient Compliance,
  Adherence, and Persistence
• Source Alliance Healthcare Information, Inc.,
  2008

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//Critical Success Factors ToOvercoming
Non-Adherence

• Patient education is key
• gt it is about changing behavior
• gt the more educated patients are about a
  particular disease, the more wiling they are
  to adapt their behavior and motivation
• Pharmaceutical company call center nurses
• gt treating patients like people!
• Better and more accurate databases
• gt allow pharmaceutical companies to analyze
  whats been prescribed and compare to what is
  already filled
• Patient Compliance, Adherence,
  and Persistence

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// Critical Success Factors ToOvercoming
Non-Adherence

• Improve the communication chain among physicians,
  pharmacists, payors
• gt minimize the misunderstandings,
  inconsistencies
• gt understand the barriers and motivators
• gt set reasonable expectations
• Leverage the pharmacist as a highly influential
  source of contact
• gt relevance why it is important to stay on
  therapy
• gt repetition takes 2 to 5 messages or
  communications to change or modify behavior
• gt comfort level patients are comfortable with
  and trust their pharmacists
• Patient Compliance, Adherence,
  and Persistence

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//Patient Relationship Management

• At the point of pharmacy, patients are thinking
  about their health
• gt pharmacist can answer questions
• Education materials need to focus on questions
  patients should ask a physician or pharmacist
• gt critical for patient retention
• Need to improve the one size fits all strategy
  within a specific indication
• gt Set expectations for specific disease state
  and patient populations (Alzheimers
  Disease)
• Patient Compliance, Adherence,
  and Persistence

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//
//Patient Relationship Management

• Must do a better job of aligning risk-reward
  scenarios
• gt patients need an accurate understanding of the
  risks and benefits of the mediation or
  therapy
• gt physicians, pharmacists, and payers need to
  communicate these facts
• gt Here is the risk if you do not take it, here
  is the reward if you do
• Need to better understand why patients do not
  comply and why they do complyit is about
  behavior
• gt the reasons why a patient chooses not to take
  his/her medication anymore may be different
  than the reasons why a patient chooses to
  take half the dose or than the reasons why
  they just forget
• Patient Compliance, Adherence,
  and Persistence

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• The motivation for taking prescriptions is
  personal
• Patient Compliance, Adherence,
  and Persistence

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//What Motivates Patients To Be
Compliant.Changing Behavior

• Counseling by physicians and pharmacists
• Pill boxes
• Email alerts / electronic reminders
• Alarm devices
• Phone calls
• Patient Compliance, Adherence,
  and Persistence
• Sources The Star Group Medical Monitor 2007,
  Available Data

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//What Motivates Patients To Be
Compliant.Changing Behavior

• Web sites / SEO
• Discount coupons
• Educational materials
• Personal health records / online diaries
• Patient Compliance, Adherence,
  and Persistence
• Sources The Star Group Medical Monitor 2007,
  Available Data

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//Measuring Success

• Actual change in prescription volume
• Need to consider integrated programs that work
  together
• Utilize surveys with all audiences test vs.
  control groups
• Use retail pharmacy and DTC communications
• Patient Compliance, Adherence,
  and Persistence

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//Measuring Success

• Utilize data from patient advocacy groups, public
  and private payors
• Physician time is limited leverage the
  pharmacist
• Give the physician a reason to address adherence
  (i.e., quality performance criteria)
• Patient starter kits, samplesability to capture
  names
• Funding.spend wisely
• Patient Compliance, Adherence,
  and Persistence

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//Measuring Success

• Utilize these multiple vehicles supported by
  pharmaceutical companies and payers
• gt Letters
• gt Newslettersincluding from 3rd parties
• gt DVDs
• gt Email
• gt Websites / Social networking / Blogs
• gt Patient assistance programs
• gt Onsite physician and pharmacy consulting
• Patient Compliance,
  Adherence, and Persistence

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//Measuring Success

• 2-10 improvements in compliance are good do
  not expect 50 range
• 1 increase in patient loyalty 10 cost
  reduction
• The success probability of selling to a new
  patient is only 5-20, while the success
  probability of selling to an existing patient is
  60-70
• Patient
  Compliance, Adherence, and Persistence
• Sources Bain Co., 2008, Marketing Metrics,
  2008

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//What Must Pharmaceutical Companies Do

• Evaluate underlying specific causes for patient
  non-compliance with their brands to guide
  effective program implementation
• Address barriers to successful program
  implementation with all audiences patients,
  physicians, pharmacists, payers
• Understand the return on investment for specific
  activitiesbe willing to analyze program results
  and refine as necessary
• Patient Compliance, Adherence,
  and Persistence
• Source Pharmaceutical Executive, March 2008

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• Questions?
• Patient
  Compliance, Adherence, and Persistence