Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Infographic: Four #Pharma Drug Adherence Challenges Faced by Patients

Infographic: Four #Pharma Drug Adherence Challenges Faced by Patients | Pharmaguy's Insights Into Drug Industry News |

Researchers still don't know why Americans who are prescribed a prescription drug to treat a chronic condition or disease so often fail to fill those prescriptions.

Pharma Guy's insight:

Patients might be more adherent if drugs had simpler names:


Meanwhile, doctors seem to know what’s going on. Read “Docs Cite Cost & Side Effects as #1, #2, & #3 Reasons Patients are Non-Adherent, Not Forgetfulness”;

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Patient Reported Outcomes Can Predict & Curb Non-Adherence

Patient Reported Outcomes Can Predict & Curb Non-Adherence | Pharmaguy's Insights Into Drug Industry News |

On average, it is estimated that over 50% of patients eventually abandon their treatment. Patient-reported outcomes (PROs) could facilitate efforts to reduce these figures. Defined as any data coming directly from patients about how they feel or function in relation to a health condition or its treatment – with no clinician interpretation to remove the patient ‘voice,’ PROs could help health organisations better optimise their ability to deliver high quality care to each individual who needs it. When patients do not take their medication as intended, patients do not meet their therapeutic goals, biopharmaceutical companies cannot maximise their commercial potential, and payers are burdened with increasing healthcare costs.


With the transformation from a provider-dominated market to one where the patient is central, there is an increasing emphasis on subjective, rather than objective, patient outcomes. Therapies need to better reflect patient needs if drug developers and healthcare providers hope to align with the reward-for-outcomes that payers insist upon and might place a premium on. PROs are proving to be a great source for insights on patient needs and thus potentially reveal effective solutions to curbing non-persistence with medication. PROs provide information on health, including symptom status, physical function, social function, and wellbeing as reported by the patient.


Today, data analytics have advanced to the point that PRO data can be used to predict which patients have a relatively high risk for non-adherence.

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Another Idea to Tackle Patient Non-Adherence Misses Two Important Points

Another Idea to Tackle Patient Non-Adherence Misses Two Important Points | Pharmaguy's Insights Into Drug Industry News |

It's been called "America's other drug problem” by the National Council on Patient Information and Education (NCPIE), “a worldwide problem of striking magnitude” by the World Health Organization, and by many, “a $300 billion problem.”


The problem, of course, is patient non-adherence (also referred by many as non-compliance), and we've all heard the statistics. Chief among them: how 50% or more of the estimated 3.8 billion prescriptions written every year are taken incorrectly or not at all. Yet, after decades of acknowledgement by governments, the medical, pharmaceutical and pharmacy communities, and a vast body of literature, the problem persists. So is it time to give up and accept that the human emotions, behaviors, and barriers that underpin non-adherence are simply too complex to be surmountable?


No! With a focus on the patient experience and behavioral economics, we can make an impact — and it starts with patient/provider communication, which remains at the epicenter of patient confidence and trust.


… consider that physicians are trained to be detectives…that is, to ask their patients a series of questions that, when combined with medical history and physical examination, enable them to determine what disease or condition is responsible for the symptoms being exhibited. Many, if not most, doctors fail, however, to use these same techniques upon follow-up visits to determine if their patients have been adherent, or not.


That's where the idea of an “adherence diagnosis” comes in. Why not create a structured and standardized series of non-confrontational, non-judgmental questions that can help doctors determine if their patients have been taking their medication as prescribed and have, at their disposal, resources (developed by medical marketers to be “patient friendly”) to assist those who are not. These can run the gamut from manufacturer copay assistance programs, reminder tools, or recommendations for how to enlist caregivers.


Think how transformational it would be if the concept of an adherence diagnosis were to become institutionalized, perhaps through mandatory CME programs?


It would behoove doctors, hospital staff, or pharmacists, therefore, to help boil it all down for their patients at the conclusion of an engagement:


  • Here's what you should remember most
  • Here's how to take what you're being prescribed
  • Here's what to do before even thinking about stopping your treatment


Meanwhile, the epic problem of non-adherence persists. New “marketing” approaches and technologies such as “smart pills,” ingestible sensors, pillcaps, gamification, rewards, and reminder apps provide intriguing solutions. Until the time when they can be operationalized to scale, however, there are ample opportunities make real inroads improving something far more basic: patient communication.

Pharma Guy's insight:

The author of this piece is Rich Feldman, Managing Partner at Source Marketing. His solution - as others suggested by other pharma marketers - focuses the blame on patients and ignores the elephant in the room, which is the main cause of non-adherence: drug side effects and high drug prices (Most physicians cite drug costs and side effects as the #1, #2, and #3 reasons why patients are non-adherent; see here: Nothing in Feldman's solution addresses those issues. Pharma marketers and doctors are reluctant to talk about drug prices and side effects, but until marketers are honest with consumers about side effects, non-adherence will never be solved (read “Medication Adherence Won't Get Better Unless Pharma Marketers Accept Some Blame”;

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To Improve Medication Adherence Among Senior Citizens, Lower the Price of Drugs

To Improve Medication Adherence Among Senior Citizens, Lower the Price of Drugs | Pharmaguy's Insights Into Drug Industry News |

It is reported that 10,000 Americans turn 65 each day. Your parents may have reached elderly status, or even yourself. Have you taken a look at the pharmaceutical therapies that your parents or you are using? How much medication do you take daily? How many doctors do you see? How many of those doctors have prescribed medications for you? Do your doctors keep records of the medications that you take, including those prescribed by other doctors? Do you also take over-the-counter drugs? Have you ever pondered about how your pharmaceutical cocktail might affect you and your overall well being? Or that different doctors that you see are prescribing medications for the same problem? Have problems of alcohol and drug misuse arisen that you may or may not recognize? Or is what you are experiencing the normal process of aging?

The Georgetown (University) Health Policy Institute advises, "A study of people aged 65 and older in eight states reports a substantial proportion of people, in particular, those with low incomes, take less medicine than prescribed" Why? Because the medications are too costly. Often they skip doses to make the medication last longer. And just to have the medicines they need, they have spent less on other necessities, like food and heat.

"Older adults' health often at risk from too many medications, including opioids," reads a headline at Author Celia Vimont reports, "The growing population of older adults who are taking many medications prescribed by different doctors, combined with the growing opioid epidemic, is contributing to the increasing problem of drug use among the elderly."

Some senior care facts are provided by the Agency on Aging, Centers for Disease Control and the National Council on Aging:

More than 43.1 million adults (1 in 7) are aged 65 and older. By 2040, it is estimated that there will be 79.7 million.

Almost 92 percent of older adults have at least one chronic condition; 77 percent have at least two.

Approximately 36 percent of older Americans have some sort of disability (hearing, vision, etc.)

Prescription drugs are important to a lot of people with chronic conditions. Adults aged 65 to 79 use an average of 20 prescription medications annually, women more than men. They also pay more out of pocket for their medications than any other age group.

Pharma Guy's insight:

"[Senior Citizens] pay more out of pocket for their medications than any other age group."

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NBER Study: DTC Ads Boost Rx Drug Adherence. More or Less Confirms AMA's Argument

NBER Study: DTC Ads Boost Rx Drug Adherence. More or Less Confirms AMA's Argument | Pharmaguy's Insights Into Drug Industry News |

While measurement in DTC advertising--in all advertising actually--is often difficult, NBER took a unique and targeted approach to assess as exactly as possible the effect of DTC ads. By using the introduction of Medicare Part D in isolated geographic areas and concentrating on 5 drugs for chronic conditions, researchers believe they were able to isolate and determine the specific effects of DTC on prescription drug use and adherence.

They found that a 10% increase in DTC ad viewing led to a 5.4% increase in the total number of prescriptions filled for the advertised drugs. That same 10% spike in viewing resulted in an increase in drug adherence by 1% to 2.5%, NBER reported.

"We find that drug utilization is highly responsive to advertising exposure," the study asserts. "Advertising increases the take-up of drug treatments and improves compliance for existing patients. Expanded take-up of prescription drugs accounts for about 70% of the total effect of advertising, while increased use among existing patients accounts for the remaining 30%."

The researchers also noted another "important component" to the increased use and compliance of drugs in general. That is, the increase and compliance wasn't just a switch from nonadvertised brands to the pushed one. Evidence showed the ads increased use and compliance of nonadvertised drug in the same therapeutic category in similar proportions, calling the effect "substantial positive spillover."

Pharma Guy's insight:

This more or less conforms what AMA said in its call for the ban on DTC advertising:  advertising “inflates demand for new and more expensive drugs, even when these drugs may not be appropriate" ( 

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Lilly's "Intermittent Wiper" Moment: Accused of Stealing Drug Adherence Tool

Lilly's "Intermittent Wiper" Moment: Accused of Stealing Drug Adherence Tool | Pharmaguy's Insights Into Drug Industry News |

In its latest legal saga, the drugmaker is going head-to-head with a woman who claims that Lilly stole her idea for a tool that helps patients' remember to take their meds.

Plaintiff Lisa Duer filed a complaint alleging that Lilly at first tried to license her patented "Take-n-Slide" adherence gadget. But after the negotiations fell through, Lilly and its supplier, Bensussen Deutsch & Associates, simply copied Duer's idea instead, the suit claims.

The drama dates back to 2010, when Duer and her distributor, Anatomed, kicked off discussions with Lilly and BDA about licensing the product. Lilly said it wanted Duer to sell her product to BDA directly because BDA was the company's supplier. Then, BDA could turn around and sell the tool to Lilly.

BDA sent Anatomed a supplier agreement, but Duer took issue with some of the terms. Anatomed told BDA about Duer's reservations, and in summer 2011, Lilly and BDA "abruptly ended discussions" to buy the product, according to the lawsuit.

But in 2013, Duer realized that Lilly and BDA had moved ahead with the product anyway, the complaint alleges. The companies copied Take-n-Slide and its package insert sheet, removed Duer's patent number from the insert and distributed the items to customers, the suit alleges. Duer only found out that Lilly and BDA were manufacturing and marketing the tool after a customer accidentally contacted her about the product, thinking it was hers.

Pharma Guy's insight:

Stay tuned for the movie!

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Is Medication Non-Adherence a Behavior Problem? I Don't Think So!

Is Medication Non-Adherence a Behavior Problem? I Don't Think So! | Pharmaguy's Insights Into Drug Industry News |

The battle to improve adherence is a collective responsibility. Success requires an integrated approach that bridges prescribers, payers, patients and pharma. Moreover, since care pathways facilitate patient engagement with other HCPs and support networks, developing collaborative strategies that exploit interactions across the care continuum is critical. Currently, many measures to combat non-adherence appear disparate and fragmented. Although pharma brand teams are developing tools to support adherence, these are often quick-fix, digital efforts that lack a cohesive, solution-oriented approach in their implementation. Many deliver only marginal gains.

Maintaining legacy approaches to medication adherence will not solve the problem. Pharma has a real opportunity to lead a collaborative effort to not only combat non-adherence, but to also redefine thinking and approach the problem from a different perspective. Identifying and responding to the drivers of non-adherence is a complex exercise, but it begins and ends with the patient.

Fundamentally, adherence is about changing behaviours. As such, progressive pharmaceutical companies are exploring the world of behavioural change and turning to user experience methodologies and behavioural economics to unlock the answers. Undoubtedly, more must be done to identify personal barriers to adherence and develop responsive services that trigger appropriate behaviour change. Ironically, pharmaceutical companies may themselves need to change some behaviours of their own.

Pharma Guy's insight:

A whopping 93% of physicians feel that "worry about side effects" was a moderate or significant reason for non-adherence (see here).

IMHO, To improve adherence drug companies should change THEIR behavior - such as focusing more on creating drugs with fewer side effects.

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Cash Payments Fail to Improve Adherence - at Least for HIV Drugs. But Wow!

Cash Payments Fail to Improve Adherence - at Least for HIV Drugs. But Wow! | Pharmaguy's Insights Into Drug Industry News |

Scientists at an AIDS conference in Seattle said paying patients as much as $280 a year to take AIDS-prevention drugs failed to significantly improve adherence or infection rates.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.

“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”

Cash payments might still work for some patients and some poor-performing clinics, she said.

Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.

Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.

But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.

The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.

Pharma Guy's insight:

Obviously, this is a blow to companies like HealthPrize whose business model is awarding prizes to patients who are adherent. Read  Eyes on the Adherence Prize: How HealthPrize Uses Financial Incentives and Fun to Change Patient Behavior.

But there are a lot of reasons why $ didn't work in this case. For one thing, the drugs appear to be for prevention of infection or that may be how they were presented to patients. If you don't have symptoms, why take a drug with potentially dangerous side effects, especially if it is difficult to use?

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Breaking Up With My Meds: "Non-Adherence" Is Not Just Dumb Patients Who Don't Follow Directions

Breaking Up With My Meds: "Non-Adherence" Is Not Just Dumb Patients Who Don't Follow Directions | Pharmaguy's Insights Into Drug Industry News |
The drugs I take for anxiety, depression and insomnia have helped, but I’ve decided to quit.

In the fall of 2014 the author decided to quit the prescription medications she has been taking to treat her anxiety, depression and insomnia, and began the process of gradually reducing her dosages. In Going Off, a series of Anxiety posts in the coming weeks, she will chronicle the challenges she faces from both the drugs and the withdrawal in her pursuit of a drug-free life.

Antidepressants make me less depressed and benzodiazepines, with the help of trazodone, calm my anxiety and help me to sleep. Since March 2013, I’ve tried various combinations of drugs, searching for the perfect balance: a stable mood, low anxiety, freedom from insomnia, minimal side effects. But balance, too, is an urban legend. When I reduce, my anxiety and depression creep back in; when I increase, my side effects range from grim to unbearable. Even at my current low doses, my hair is falling out. My thinking is slowed, my creativity stymied. When I work, I feel as though boulders are strapped to my brain. I’m constantly thirsty. I’ve lost my taste for exercise, a mood-enhancer I’ve long relied on, and become more sedentary than I’ve ever been. Perhaps most disruptive of all, depression still lies, dead weight, on top of me — a few hours here, a few hours there — and medicated, I feel less motivation to wriggle out from under it.

I’m not free from anxiety, either, particularly anxiety over my medication. I worry about the long-term effects of these drugs, which are still relatively new to consumers. I worry about Big Pharma. My stomach clenches when I read about covered-up studies and the ugliest side effects of the very medications pharmaceutical companies hard-sell to psychiatrists, including to pediatric psychiatrists. I feel great discomfort with my doctor’s Celexa clock.

NEXT: Dealing with the side effects of my drugs.

Pharma Guy's insight:

So many pharma marketers think they can improve adherence by just educating consumers and developing mobile apps to remind patients to take their medications, as if "non-adherence" was just dumb patients who can't follow instructions!

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Sharing Doctors' Notes Online Increases Adherence

Healthcare has always been one of the most difficult markets for entrepreneurs to break into, but with major reforms changing the way that medical products and services are paid for, and a fresh appetite for investment in new technologies to improve efficiency, this could be prime time for medical start-ups.

One of the biggest challenges for doctors is making sure their patients understand what is said to them during a consultation. In truth, the majority have forgotten most of it by the time they get home.

The problem Up to 80% of medical information provided to patients by healthcare practitioners is forgotten, immediately.The problem has huge social and economic consequences. In the US alone, billions of dollars are wasted as a result of people not following their doctors’ recommendations, while many thousands of patients become seriously ill, or die, as a result.

It was this mismatch between doctors’ orders and patient response that prompted Italian entrepreneur Floriano Bonfigli to come up with a solution; Collabobeat a patient engagement platform that facilitates better sharing of doctors’ notes with their patients.

The doctor writes and shares the visit notes with the patient, who is then able to comment and re-share with their doctor. The result is a secure, open and much clearer on-line conversation.

Pharma Guy's insight:

The concept had been trialled in three US hospitals, involving around 100 physicians and 10,000 patients. At the end of it 70% of patients had increased their medical adherence, while 92% of the doctors had spent less time addressing patients’ questions outside the consultation. Read more here.

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For Forgetful, Cash Helps the Medicine Go Down

For Forgetful, Cash Helps the Medicine Go Down | Pharmaguy's Insights Into Drug Industry News |

It has long been one of the most vexing causes of America’s skyrocketing health costs: people not taking their medicine.

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fillprescriptions 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.

“It’s better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital,” said Valerie Fleishman, executive director of the New England Healthcare Institute, a research organization, who said that about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. “Financial incentives are a critical piece of the solution.”

In a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis, or death.

“I would forget to take it,” and feel “like I couldn’t breathe,” she said. Or she would “take two in a day,” and develop bruises from uncontrolled internal bleeding.

But in the six-month lottery program, she pocketed about $300. “You got something for taking it,” Ms. Parker said. Suddenly, she said, “I was taking it regularly, I was doing so good.”

Skeptics question if payments can be coercive or harm doctor-patient relationships. “Why should people who don’t want to take medication be paid, when prudent people who take medication are not?” said Dr. George Szmukler, a psychiatry professor at King’s College London.

Joanne Shaw, who runs a department of Britain’s National Health Service, asked: “Will others think, ‘If I behave like a potential noncomplier, I’ll get money for taking medication?’ And once you start paying people to take medication, when do you stop paying them?”

Health experts wonder if people will realize their health has improved and maintain medication without money. Or must payments be continued indefinitely, even increased?

Still, with patients forgetting medication, finding it inconvenient, fearing side effects, or considering it unnecessary if they feel better, important players are turning to financial rewards. Aetna, the insurer, helped pay for part of the Philadelphia experiment, and is considering using that or another method.

Pharma Guy's insight:

Listen to this podcast conversation with Tom Kottler, CEO, and Katrina S. Firlik, M.D., Chief Medical OfficerHealthPrize, about the company's innovative, compelling approach to solving one of pharma's most perplexing puzzle: how to improve medication adherence.

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If Rx Drugs Had Simpler Names, Would Patients Be More Adherent?

If Rx Drugs Had Simpler Names, Would Patients Be More Adherent? | Pharmaguy's Insights Into Drug Industry News |

People tend to strongly believe that pharmaceutical drugs with simpler and easier-to-pronounce names have fewer dangerous side effects, according to a study in the Journal of Health Psychology.

In three experimental studies, Simone Dohle and Michael Siegrist of the University of ETH Zurich provided groups of participants with names of imaginary medications. The researchers then asked the participants to rate the medications on how many hazardous side effects they believed the drugs had, and on how willing they would be to take or buy the drugs.

Participants consistently rated medications with easier-to-pronounce names to be safer — even though they rated them the same as complicated-sounding drugs in terms of effectiveness.

“In three studies, we found strong evidence that fluency is most relevant for evaluations of drug names,” wrote the researchers. “In general, people judged drugs with simple names as safer, assumed that those drugs had fewer side effects and were more willing to buy those drugs.”

They suggested the findings had importance for medication adherence, and that the results would likely have been even stronger with people with real illnesses evaluating real medications. “Quite possibly, people may react differently when they are really affected by a disease,” wrote the researchers. “However, the existing literature shows that the influence of heuristic cues (such as the complexity of a name) is even more pronounced when people are stressed and distracted. Accordingly, we may have even underestimated the effect of a drug name’s complexity on people’s evaluations and preferences."


Further Reading: 

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How Much Does #Pharma Lose Each Year Due to Medication Nonadherence?

How Much Does #Pharma Lose Each Year Due to Medication Nonadherence? | Pharmaguy's Insights Into Drug Industry News |

In 2012, we first estimated the annual economic loss to pharmaceutical companies because of medication nonadherence in chronic health conditions. Our report, conducted with Capgemini Consulting, estimated that nonadherence cost pharma $564 billion a year.

In refreshing this report to re-estimate the costs of medication nonadherence based on 2015 data, we look to fortify pharma’s focus on medication adherence as a revenue-generating strategy. Doing so will offer a genuine win-win opportunity, both increasing revenue and improving patient outcomes.

Preview key findings from our 2016 report refresh or download the full report with our new foreword.

Estimated Global Costs of Nonadherence, 2015

  • Total global pharma revenue: $1.1 trillion
  • Total potential global pharma revenue: $1.74 trillion
  • Estimated global revenue forfeited to nonadherence: $637 billion
  • Percentage of total global potential revenue recoupable by improving adherence: 37%


Estimated U.S. Costs of Nonadherence, 2015

  • Total U.S. pharma revenue: $425 billion
  • Total potential U.S. pharma revenue: $675 billion
  • Estimated U.S. revenue forfeited to nonadherence: $250 billion
  • Percentage of total U.S. potential revenue recoupable by improving adherence: 37%


Results of HealthPrize Influence on Adherence and Engagement

  • A 14.6 percent lift in market share for a leading prescription dermatology medication
  • A 99 percent reduction in prescription refill gap days for a cholesterol lowering drug
  • Patient engagement rates that meet or exceed engagement with top social media platforms
  • Prescription fill rates 2 to 4 times higher than a brand’s historic baseline.
Pharma Guy's insight:

Related articles:

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Everyone Loses When Doctors Trust Pills Over Patients. Implications for Adherence.

Everyone Loses When Doctors Trust Pills Over Patients. Implications for Adherence. | Pharmaguy's Insights Into Drug Industry News |

Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The L.A. Times’ review of evidence—including three decades of court cases, investigations, patient and sales rep testimonies—provides good data that the drug's effect may not, as claimed by Purdue, last for 12 hours across the board (read “OxyContin's 12-hour Problem: Misrepresentation of Efficacy Leads to Addiction & Purdue Knew It”; ).


In other words, OxyContin may not be the magical drug that provides longer-lasting pain relief than all other oral opioids. Purdue has argued that the L.A. Times’ claims are not valid, and it remains to be seen whether there will be federal investigations into this claim as recommended by Massachusetts Sen. Edward Markey.


In the meantime, as a doctor who bought the hype about OxyContin’s twice-daily efficacy for decades, I’m frustrated. While my gut sense that someone was pulling the wool over my eyes was correct, I was casting blame in the wrong direction—toward my patients.

Pharma Guy's insight:

When drugs don't work as advertised - especially if they have side effects that are downplayed by sales reps - it impacts what the drug industry terms the "problem" of lack of adherence. Patients will stop taking drugs that don't work or have side effects and thus they will be labelled as non-adherent and seen as the problem that has to be solved by more advertising or by more adherence apps and programs, when in fact it is the drug that is the problem. That's why I say “Medication Adherence Won't Get Better Unless Pharma Marketers Accept Some Blame”;

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Are #Pharma Adherence Programs Just Another Form of Marketing?

Are #Pharma Adherence Programs Just Another Form of Marketing? | Pharmaguy's Insights Into Drug Industry News |

Drug companies around the globe are spending big to push patients to take their pills.

The pharma industry loses tens of billions in worldwide sales each year when patients don’t fill, or refill, their prescriptions.

So drug makers from London to Tokyo to Cambridge, Mass., are pouring money into programs aimed at cajoling — or nagging — patients to take every last pill their doctors prescribe. The companies are investing in smart pills that will send alerts when they haven’t been swallowed at the prescribed time. They’re subsidizing gift cards to thank patients who remember to refill. They’re paying patients to go on talk circuits to tout the virtues of taking medication properly.

They’re even lobbying the federal government for permission to pay third parties, such as pharmacists, to encourage patients to take their pills.

Drug companies say these investments are focused on improving patients’ health. “We’re not pushing pills here, we’re pushing adherence,” said Joel White, president of the Council for Affordable Health Coverage, an advocacy group that works with the industry.

But Matt Lamkin, an assistant professor at the University of Tulsa College of Law who’s studied the issue, sees another motive.

Pharma companies have the sense “that they are leaving billions on the table” when medicine isn’t taken and prescriptions aren’t filled, Lamkin said. The push to improve adherence, he said, “reframes the goal of boosting sales as a goal of public service.”

Pharma Guy's insight:

There have been many attempts by the drug industry to improve medication adherence, but it has been a tough challenge. The industry, however, has not given up. The new battleground for combating non-adherence is the mobile smartphone and the smartphone app is the weapon of choice. Read "Adherence: Do We Really Need an App for That?"; 

You might also like to read this Pharma Marketing News article: "Eyes on the Adherence Prize": 

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Digital Abilify for Improving Adherence. Is it a Solution for a Non-Problem?

Digital Abilify for Improving Adherence. Is it a Solution for a Non-Problem? | Pharmaguy's Insights Into Drug Industry News |
Is this technology really the best fit for patients who are mentally ill?

GETTING PEOPLE TO take their pills is hard, especially with mental illnesses like schizophrenia and bipolar disorder. But to use the language of techno-optimism: “There’s an app for that!”

No, really. This month, the Food and Drug Administration accepted an application to evaluate a new drug-sensor-app system that tracks when a pill’s been taken. The app comes connected to a Band Aid-like sensor, worn on the body, that knows when a tiny chip hidden inside a pill is swallowed—so if patients aren’t keeping up with their meds, the program can alert their doctors.

The drug here is Abilify, a popular antipsychotic from the pharmaceutical giant Otsuka, and the sensor and the app come from Proteus Digital Health, a California-based health technology company. The FDA has already approved the drug and the sensor system separately—now, they’ll be evaluated together under a whole new category of “digital medicines.” If approved, the ingestible sensor can actually be used in the pill.

Their sensor is primarily aimed at people who want to take their meds but forget. Taking a pill every day is a hassle, which can get in the way of adherence, and the drugs can have side effects that can be more than minor. 

Pharma Guy's insight:

A whopping 93% of physicians feel that "worry about side effects" was a moderate or significant reason for non-adherence (see here).

IMHO, To improve adherence drug companies should change THEIR behavior - such as focusing more on creating drugs with fewer side effects.

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Silja Chouquet Says DE-scribe Medicines to Improve Adherence

"If we could develop something to get people to take the medicine we prescribe them, it would have a greater benefit to society than any new drug we could develop."

Pharma Guy's insight:

Silja suggests that the main reason patients don't take their medicines as ordered by their physicians is their busy lifestyles. She suggests that pharmaceutical companies apply resources and their brains to come up with a solution that helps people take their medication and use these insights to develop the next generation of treatments.

Most physicians, however, cite drug costs and side effects as the #1, #2, and #3 reasons why patients are non-adherent (see here: 

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Should #pharma pay people to look after their health & take their meds?

Should #pharma pay people to look after their health & take their meds? | Pharmaguy's Insights Into Drug Industry News |

People don’t do what’s in their best interest in the long term for many reasons. When making decisions we tend to take mental short cuts; we allow the desires and distractions of the moment get in the way of pursuing what’s best.

One such “irrationality” is our tendency to focus on the immediate benefits or costs of a situation while undervaluing future consequences. Known as present bias, this is evident every time you hit the snooze button instead of going for a morning jog.

Researchers have found effective incentive programs can offset present bias by providing rewards that make it more attractive to make the healthy choice in the present.

Here are a few basic principles to consider. First, small rewards can have a big impact on behaviour if they’re provided frequently and soon after the healthy choice is made. We have found this to be true in the context of weight-loss programsmedication adherence, and even to quit the use of drugs such as cocaine.

Games of chance are an effective way of distributing rewards as research has foundpeople tend to focus on the value of the reward rather than their chance of winning the prize. Many people think that a 0.0001 and a 0.0000001 chance of winning a prize are roughly equivalent even though in reality they are vastly different probabilities.

Incentives are particularly effective at changing one-time behaviours, such as encouraging vaccination or attendance at health screenings. But with increasing rates of obesity and other lifestyle-related diseases, we need to focus on how incentives can be used to achieve habit formation and long-term sustained weight loss.
Pharma Guy's insight:

Compare this with conclusions of this report: "Cash Payments Fail to Improve Adherence"

Sindiso Dube's curator insight, March 24, 2015 8:10 AM

If giving incentives to workers will promote a healthy life style and lead to a healthy workforce, in my opinion this results as a gain to the employer rather than a loss. A healthy workforce can lead to reduced loss of production and workplace injuries. A healthy lifestyle can lead to a happy workforce.

Amy Rattray's curator insight, March 25, 2015 6:25 AM

I believe that the more jobs out there, the less of a percentage there will be of unemployed people out there. But the fact that the government is willing to cut back more jobs is sad. The government is supposed to build this country up not tear us down. So I fully agree that we should pay everyone that actually works and doesn't sit on the doll.  

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Docs Cite Cost & Side Effects as #1, #2, & #3 Reasons Patients are Non-Adherent, Not Forgetfulness

Docs Cite Cost & Side Effects as #1, #2, & #3 Reasons Patients are Non-Adherent, Not Forgetfulness | Pharmaguy's Insights Into Drug Industry News |

Healthprize, the adherence gamification company, wanted to find out how physicians think about patients not taking their medications. They looked at physicians who deal with the "big three" metabolic conditions: hypertension, diabetes, and high cholesterol. The results were in places expected and surprising.

We can see that education on side effects, including ways to mitigate them, and cost support are two important ways that pharmaceutical companies can help patients get the benefit of their medications.

Other factoids from this survey:

A whopping 96% of respondents placed the importance of medication adherence for clinical outcomes at 8 or higher (on a 10-point scale). It is clear that physicians understand that medication adherence is critical for their patients.

Likewise, respondents said that they engage in counseling during initial visits and during follow-ups. 92% said they “often” or “always” counsel patients at the time of prescription and 94% said the same for follow-up appointments.

Pharma Guy's insight:

A whopping 93% of physicians felt "worry about side effects" was a moderate or significant reason for non-adherence. Hopefully, new FDA guidelines for an easy to read and understand "Patient Brief Summary" in print direct-to-consumer ads will help mitigate that worry . For more on that read "Disclosing Risk in DTC Print Ads".

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Take a Pill a Day or Risk Immediate Death: Is That Choice Really A Significant Factor in non-Adherence?

Take a Pill a Day or Risk Immediate Death: Is That Choice Really A Significant Factor in non-Adherence? | Pharmaguy's Insights Into Drug Industry News |
Four out of ten people would be willing to accept some degree of risk of immediate death rather than having to take a daily pill to prevent cardiovascular disease (CVD). 

Some 8.2% of participants said they would be willing to shorten their life by as much as two years, while around 21.6% would trade between a week and a year. Some 12.8% said they would accept a minimal risk of death (0.0001% risk), while 9.0% said they would take a 10% chance of death. Most people (62.1%), however, were not willing to gamble any risk of immediate death. On average, the participants were prepared to pay US$1,445 to avoid taking a pill each day for the rest of their lives, with 21.9% saying they would pay $1,000 or more, including 2.8% who would pay $25,000. Some 42.8% would not be willing to pay anything. 

The ultimate aim of the research was to consider the implications for medication strategies of such perceptions. “We tried to measure how much the act of taking a pill — obtaining it, remembering to take it and actually taking it – interferes with one’s quality of life,” says lead author Robert Hutchins, an internal medicine physician at UCSF. “The act of having to take a daily pill can have a large effect on an individual’s quality of life. And on a population level, even for the small reductions in quality of life like those found in this study, that effect multiplied across millions of people can have very large effects on the cost-effectiveness of that drug for a population.” 

Pharma Guy's insight:

I would love to see how this survey was done. I mean, if I don't take my pravachol pills every day, do I really risk death? Versus if I take a trip on an ocean liner?

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FDA to Study Effect of Generic Pill Size & Color on Adherence

FDA to Study Effect of Generic Pill Size & Color on Adherence | Pharmaguy's Insights Into Drug Industry News |

Generic drugs make up approximately 85 percent of all human prescription drugs prescribed in the United States. While generic drugs are required to be pharmaceutically equivalent and bioequivalent to their brand-name counterparts, generics made by different manufacturers may differ substantially from their brand-name therapeutic equivalents and from each other in their physical appearance (e.g., color, shape, or size of pills). When pharmacists switch generic drug suppliers, patients refilling their generic prescriptions may therefore experience changes in their drugs' appearances. These changes may result in patient confusion and concerns about the safety and effectiveness of the generic drug products. Studies indicate that patients are more likely to stop taking their generic medications when they experience a change in their drugs' physical appearances, leading to harmful clinical and public health consequences as well as increased health care costs from avoidable morbidity and mortality.

To provide additional information that may help guide regulatory policy or pharmacy business practices, we intend to conduct surveys of pharmacists and patients about their perceptions about and experiences with generic drugproduct pill appearance change. These surveys are intended to further our understanding of the relationship between changes in pill appearance and non-adherence to prescribed therapeutic regimens. The surveys may enable us to investigate factors that may explain the association between changes in pill appearance and non-adherence, including which factors could be modified to improve the safe and effective use of generic drugs.

We intend to survey a national cohort of pharmacists about their experiences with dispensing generic drug pills that differ in appearance from previous refills of the same medication and dosage level (e.g., when pharmacies switch generic suppliers).

Pharma Guy's insight:

The Generic Pharmaceutical Association (GPhA), in comments to FDA (here), reminds the agency that "there is no provision in Hatch Waxman allowing FDA to deny approval of an ANDA based on differences in physical attributes between a generic product and the listed drug it references. The premise of the Draft Guidance, that generic drugs must mimic the reference listed drug in size and shape, has no basis in law. In our view, an FDA action related to the physical characteristics of generic drugs must be tied to the safety of those drugs to avoid exceeding FDA's statutory mandate." 

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Understanding the psychological blocks in medicine-taking: how pharma can help

Understanding the psychological blocks in medicine-taking: how pharma can help | Pharmaguy's Insights Into Drug Industry News |

Medicines adherence remains a massive problem for healthcare systems, the pharmaceutical industry and patients, leading to increased disease burden and personal risks. In this new white paper, Hannah Gagen looks beyond traditional approaches into the psychology behind adherence to understand the real challenges and solutions.

The major focus for the pharmaceutical industry is market access – making sure that novel medicines make it through the clinical and cost barriers to reach patients. But even once this has been surmounted a potentially bigger hurdle exists – adherence. Failing to take medicines as prescribed is expensive for healthcare systems and pharma, plus potentially damaging, or even life-threatening, for patients.

Despite numerous attempts to tackle non-adherence, it remains a significant challenge. But perhaps we are not looking at solutions the right way? Here, Hannah Gagen, from Boehringer Ingelheim, challenges traditional solutions and takes a more in-depth look at the psychological factors behind this problem and how they can inform new approaches that underpin a more collaborative resolution between doctors, patients and the pharmaceutical industry

Read this white paper from Boehringer Ingelheim to understand:

• Key definitions and metrics around medicines non-adherence

• Factors underlying intentional and non-intentional non-adherence

• Expert views on the psychology of adherence

• How pharma needs a new collaborative approach to tackling adherence

Pharma Guy's insight:

As Kevin Dolgin, president of French healthcare company Observia explains, there is still a long way for us to go. He points out that while patient adherence budgets have quadrupled over the past five years (to roughly $1 million on average per product per annum, according to US data), spending on traditional promotional channels are still 30 times higher, as shown in the figure above.

Check this out: 

The Adherence Problem: Are Patients Just Forgetful, or Are They Rebellious?
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