Adherence « Return On Focus --- --- Return On Focus


    Non-Adherence Can’t be Overcome with Information Alone

    October 4, 2015

    We've known for over 50 years that providing information alone to people does not change their behavior? - Victor StrecherAfter nearly a decade of examining the adherence challenges and interventions of multiple disease categories, it’s become apparent that the pharmaceutical industry inherently believes that it can change patients’ adherence behavior behavior just by providing information. In our adherence analyses, we consistently see companies generating reams of new product or disease information intended to educate patients on the importance of adhering to therapy and the potential risks of non-adherence. This level of time and monetary investment is a clear indicator that marketers believe that awareness (or ignorance) is the primary contributing factor to the non-adherent behavior they are trying to mitigate.

    Unfortunately, if this approach is the sum total of your adherence mitigation strategy, you’re likely wasting your money. Don’t believe me? Well, let’s consider an adherence topic a bit closer to home. (more…)

    Adherence Curve Never Gets Better Than the Pivotal(s)

    January 28, 2013

    Of all the predictive questions one faces in launching a new biologic or pharmaceutical product, the ceiling of your product’s adherence curve may be one of the easiest to tackle with a high degree of accuracy. The answer to this question is buried within your clinical study report(s).

    Trial Adherence CurveThe fact is that the ceiling for your adherence curve is revealed by carefully examining the ITT (intent to treat) analysis by time increment, preferably monthly for most brands. Once you’ve plotted this curve, you can safely assure your Senior Management that it won’t get any better after launch.

    But wait, why can’t your adherence curve get any better?

    • HCP (i.e., $) and patient (i.e., free quality medical care) financial incentives for trial adherence are not repeatable in the real world
    • Interventions (e.g., personalized patient follow up by the practice) employed are generally not scalable for use with the general disease population
    • Patient population careful culled to maximize trial completion does not reflect your real world patient pool

    While it may not be possible to recreate the adherence curve from the Pivotal trial(s) in the real world, an in-depth understanding of the adherence data, challenges and adherence-enhancing interventions from the Pivotal trial(s) is your first step in building a validated adherence framework for your brand.

    What next? Pick up the phone and introduce yourself to the clinical study coordinator for the site that had the best percent completion for your Pivotal. I’m confident you might learn a few things!

    Co-Pay Card “Played Out”: Manufacturer Belief, Not Patients’

    January 21, 2013

    We have previously discussed the dangers of relying on just a co-pay card to serve as your adherence strategy. Despite this, I believe the co-pay card is still an important tool in the marketing armamentarium.


    However, I’ve begun to notice that because the co-pay card is no longer the new, ‘bright shiny object’ among most marketing and sales teams, its perceived efficacy is believed to have waned. I’m here to tell you that this belief of the Co-Pay Card being ‘played out’ only exists within the minds of manufacturers.

    Why do I say that? In a recent ROF study of patients in a symptomatic, heavy DTC marketing category, we found that most patients have not only not used a co-pay card, but many are not even aware they exist for their medications. Here are some of the topline results:

    • ~98% of the patients had not used a co-pay card for the condition
    • ~96% had never used a co-pay card for any condition despite suffering from an average of 2+ comorbidities in addition to the one studied
    • Among the 4% that were even aware of co-pay cards, almost all had avocations that put them in the doctors office, but this fact still didn’t increase their own use of them

    Note that all the participants in the study were on a prescription product, many of which currently offer co-pay cards.

    The results of this study illustrate that more diagnostics are needed before we can conclude that co-pay cards are played out. The high number of people not using co-pay card could be due to a variety of factors such as low awareness, ineffective promotions, etc. It’s tempting to move on to the next ‘bright shiny object’ but conducting the right research on your existing set should be the first order of business!


    FIFO Principle – First Patients on a Drug Often Determine Whether It’s First Out of the Armamentarium!

    October 29, 2012

    Train WreckAccording to Wikipedia . . .FIFO is an acronym for “First In, First Out.” It’s typically reserved for Accounting, but I’d like to apply this concept to new product adoption by today’s physicians. In the mad rush to meet forecasts, the idea of advocating appropriate use in professional marketing communication is often sidelined. In fact, marketing teams often estimate brand use in patients that were not even studied in clinical trials because physicians might use the product there and they can expand their sales potential by doing so.

    This strategy, however, is wrought with complications. You see, the FIFO Principle in pharmaceutical marketing is that the likelihood of a new product being adopted into a physician’s armamentarium is directly linked to the outcomes experienced by the first few patients prescribed the product. In other words, the characteristics of the initial patients (“First In”) and their corresponding results determine whether your product begins to become habit or is jettisoned (“First Out”).

    So, what’s the launch product marketer’s answer to the FIFO Principle? Appropriate Use – being crystal clear on patient selection from the outset with physicians. It’s not just about ‘painting a picture’ for the field representative to aid in selling. It’s about pointing out which patients can benefit from the product the most based on the results of rigorous clinical testing. The “First In” (FI) of the FIFO is essential in determining commercial success. A few obvious tips that continue to be ignored:

    • Study Population – Clearly communicate the patient types included in your pivotal studies. The physician shouldn’t expect great results when prescribing your product in a sicker patient population.
    • Line of Therapy – If you’ve been approved ‘first-line’ or in treatment-naïve patients then emphasize this in your promotional materials. Just be sure you’re definition of first-line is aligned with the physician’s definition.
    • Comorbidities – If the clinical trials for your brand excluded specific patient types, don’t be afraid to tell your prescribing physicians about that. There is always a chance that a comorbidity can compromise clinical success.

    Think about it . . . as an industry, there is a strong tendency to open up the experiential patient pool at launch as wide as possible just so doctors can get some product use and drive the sales trajectory. But driving initial use in the wrong patient will not sustain brand growth. FIFO is pervasive in pharma and the marketing landscape is littered with its casualties. Just look around.

    Where is the Feedback Loop in Your Adherence Plan?

    July 22, 2012

    Results from our research indicate that the number of adherence-enhancing interventions that pharmaceutical and biotechnology marketers have put together to ‘help’ overwhelms both physicians and patients alike. The issue is more pronounced when you look at the fact that the average baby boomer is taking more than five chronic medications a day, which translates into the potential of five different adherence programs trying to gain mindshare with one patient at the same time.

    As one physician interviewed in market research recently aptly put it – “Every prescription product has an adherence program, but not every prescription product needs one.” So if you have a brand that really needs a program, how do you ensure it gets the appropriate attention? It has to start with the healthcare prescriber, but how do you get them to engage with and recommend your program for their patients?

    Adherence Feedback LoopThe main complaint that physicians express with adherence programs is that there isn’t a feedback loop to let them know how their patients are doing. Many physicians understand the issues with HIPAA and would be satiated with an aggregate view of the program’s utility, and incorporating a feedback loop into your adherence plan could differentiate your adherence program for both the prescriber and the patient.

    Would you really recommend someone participate in a program without ever finding out what people thought about it? Why should you expect doctors to do the same?

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