Medication adherence and the state of being “normal”

February 18, 2010 – 4:25 pm by Chris

I spent a good deal of time Wednesday participating in conference calls for Frost & Sullivan’s 5th Annual Patient Adherence Congress in Philadelphia in March. I’m moderating a panel at the end of the day, about social media and how it can be used to create and improve pharma adherence programs. The panel features heavy hitters such as Marc Monseau of Johnson & Johnson, Dennis Urbaniak from Sanofi-Aventis, Ambre Morley from Novo Nordisk, Bill Drummy of Heartbeat Digital, and Melissa Davies of Nielsen Online.

To say that pharmaceutical marketers would love figure out why patients won’t take their medication on a consistent basis is like saying whales are big mammals. Getting patients to adhere to their prescriptions would yield more sales for the industry, and noncompliance is costing the industry about $100 billion a year. Yet despite many concerted efforts, patients aren’t filling their prescriptions. For example, a Massachusetts study found that 22% of prescriptions were never filled, and the rate was even higher, 28%, for first-time prescriptions. One of the theories is that for health conditions with few overt symptoms, such as heart disease and diabetes, people don’t feel the need for the medication. Cost could also be another contributing factor.

Some companies are using cellphone and e-mail apps to give medication reminders to patients. But as Jonathan Richman of Bridge Worldwide says at his blog Dose of Digital, “Are you reminding me, or annoying me?” In evaluating some of these apps, he found most of the reminder programs to be annoying. “They are annoying because they aren’t smart and don’t learn from your actions (or lack of actions),” he explains.

Are these programs increasing compliance? Perhaps incrementally, but marketers are willing to take an incremental increase, because a little bit of $100 billion is better than nothing at all.

Yet, as Mr. Richman points out, so many of these apps and devices are “glorified alarm clocks.” Can’t the pharmaceutical industry do any better?

I believe it can and it will, and social media can help reveal some of the pieces to the adherence puzzle. I hope the panel I’m moderating provides interesting insights and suggestions on some ways social media can be applied to the medication adherence problem. But I also believe that the more pharma looks into this problem, the answers the industry will receive will be a little surprising, and the problems may be in parts of the healthcare system that pharma seemingly has very little ability to influence.

For example, take a typical prescription-filling experience. I have never been able to get my local pharmacy to fill any prescription that I have brought in, in anything less than an hour. That goes for even the few that a doctor was able to phone in. For a person with a chronic disease, how much of their time gets taken up in pharmacy visits? How many times have they had to cut out early from work, cut short an enjoyable activity, to rush to a pharmacy and get a prescription filled?

And for those who receive prescriptions through the mail, there’s another unique stress, as someone has to be around to sign for the package (especially if it’s a biologic). Although receiving drugs by mail is great for retirees, it’s not so great for people who head off to work early in the morning and don’t return until late in the evening, and can’t necessarily rely on the neighbors to sign for stuff.

Additionally, to get refills on many medicines, a doctor may want the patient to come in for an appointment and a consultation. This is only proper, and for drugs that may require monitoring for liver function or depression or other side effects, absolutely necessary. But if the medication is due to run out in a week or a few days, and the only appointment available is two weeks from then (because patients who are out-and-out sick take priority), then what is the likelihood that the patient will take the steps to get your refill? For some patients, these chances are much less than they were before.

Mr. Richman was also quite puzzled by the attitudes of cancer patients who wouldn’t take their medicines. He believes that these patients are just not “forgetting” to take their Gleevec or Arimidex. In a way, I believe he is right. And in another way, I believe he is wrong.

I believe that the cancer patients can get neglectful or “forgetful” because of their longing for normalcy. Anything that reminds them of how fragile that normalcy is – like having to stand around in a pharmacy waiting for yet another refill, get up extra early on a day when they planned to sleep in to sit in a doctor’s office or hospital waiting room for treatment or testing, endlessly negotiate around everyday or enjoyable activities – can be another twist of the knife, reminding them of the crisis that led them to be on some medication for weeks or months or the rest of their lives. In the months and years after recovery, time softens the memories of that hell they had to go through, but having to plan around obtaining the medicine they need to keep themselves alive, the additional doctors’ appointments, having to ask for yet another day off for a doctor or lab appointment after they’ve just gotten back to work, are diggingly sharp reminders that their lives will never be quite normal again.

As for those diabetes and heart disease patients who may feel relatively OK, the longing for normalcy can also apply to them. It’s so easy not to do something that reminds us of unpleasant times and Americans in general have absolutely no threshold for inconvenience. And I haven’t even brought up the challenges and obstacles thrown in front of patients by insurance companies. Go ahead and ask around; I bet everyone you know has a horror story or saga of irritation to share.

In the end, social media may help the pharma industry figure out the complex psychology and needs of each patient, and help create individual, tailor-made adherence programs for them. Social media may help companies focus less on the brand and more on the patient. That’s the goal, at least. In the meantime, I’m looking forward to more discussion on March 16 in Philadelphia.