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    5 Keys to Effectively Addressing Adherence

    5 Keys to Effectively Addressing Adherence

    June 17, 2012

    5 Keys to Addressing AdherenceOver the last year, I’ve noticed a renewed interest in applying our Evidence-Based Marketing principles to effectively address adherence. It’s a stark contrast to the phenomenon I discussed in our January 2011 blog post on adherence.

    What I’ve found across the dozen or so Level of Evidence (LOE) Appraisals is that there are 5 keys to effectively addressing adherence.

    1. Become a Student of the Game – Capitalize on available academic and clinical literature that addresses adherence and adherence-enhancing interventions related to your brand / disease state
    2. Think Beyond the Patient – Adherence or non-adherence involves more than just the patient…HCPs (both physicians and nurses) also play a critical role
    3. Uncover the Factors of Influence – Non-adherence in any category is comprised of multiple factors, with varied weighting – before designing a program, it is critical to understand the factors that need to be addressed
    4. Accurately Annotate the Curve – Reasons for non-adherence change over the course of treatment – understanding the nuances of your adherence curve is an essential input to developing impactful interventions
    5. Focus on the First 90 Days – The first three months of therapy are the most critical for a chronic therapy and effectively addressing adherence typically requires a concentrated effort during this initial treatment phase

    Still not sure where to start? Why not capitalize on our adherence expertise, our normative data set, and our ‘keys’ to benefit your brand. After all, you shouldn’t have to pay for a learning curve.

    The Role of Dose Titration in Medication Adherence

    May 14, 2012

    There is an aspect of non-adherence that is often overlooked, but critical to treatment success. It’s dose titration, and the truth is, in many categories, doctors aren’t that good at it. We recently completed a patient market research study for a brand launched almost six years ago in which 60% of the patients who had discontinued for suboptimal results had not been titrated to the maximum dose prior to discontinuation. Seriously?!

    Well it turns out that when ROF conducted market research on the MD side, we confirmed this finding and determined that, despite the product being on the market for a number of years, there was a surprising lack of awareness of the actual dosing used in the clinical trials. Physicians had believed for years that the starting dose was the optimal dose. In fact, less than 50% of the brand prescribers who participated in the research were aware that the vast majority of patients in the trials were treated with the higher dose.

    Marketing efforts to increase awareness of optimal dosing have resulted in increased use of the higher dose over time—from 16% of total brand sales last year to 21% this year with the most significant gains among frequent prescribers.

    Pharma is often quick to blame patient behavior as the root cause for the levels of non-adherence that plague our industry, but there are often other contributing factors that need to be considered. Convincing one physician to titrate the majority of patients on a given brand versus persuading a single patient to be more adherent to a sub-optimally dosed product provides deeper, more lasting returns.

    Before you invest significant dollars in a program designed to improve adherence with your brand, make sure you know what is driving non-compliance and discontinuation in the first place. What you find might not just impact what you say, but to whom you need to say it.

    Addressing Adherence Starts With Understanding of the Factors Impacting Adherence for Your Category

    March 2, 2012

    Adherence LOE AnalysisIf you’re like most biopharma companies, increased adherence is one of your critical success factors for 2012. I’m here to tell you that there is a science behind addressing adherence that goes beyond just selecting a co-pay card offer and sending a string of emails to brand users. Would you expect anything less from the developers of Evidence-Based Marketing?

    The first step in addressing adherence for your brand is to start by conducting a well-formulated literature search for your category and your product. Recently, we showed a Client the wealth of data published by independent clinicians and academics on adherence with their brand that they were completely unaware of . . .boy, was that uncomfortable!

    Even if you don’t find anything in the literature on your brand, you’ll likely find adherence information on the category including known non-adherence factors and overall weighting. Here are the results of a project that we recently worked on for factors and weighting for a specialty care product:

    • Cost (27%)
    • Side Effects (20%)
    • Unpleasant association with medication (20%)
    • Uncertainty about effectiveness (18%)
    • Forgetfulness (15%)

    If this was your brand, that co-pay card you have that’s supposed to be the silver bullet for adherence would likely only address, at most, 27% of the issue. How do we know so much about this? Because, we look to the existing evidence for both a brand and category before jumping to adherence tactics and KPIs.

    Don’t understand the science behind adherence for your brand? Give us a call and we’ll demonstrate what’s already known about your category and just maybe your brand.

    Help! I’m Drowning in Adherence-Enhancing Interventions

    September 30, 2011

    Leave it to biopharma to over-correct and make improving adherence (compliance+persistency) more of an issue that it needs to be.
    Why do I say that?

    When I’m doing my second level of evidence appraisal this month that recommends a ‘harmonization’ strategy due to an over-abundance of adherence-enhancing interventions, I know we have an issue in the industry.

    I’ll suspend disbelief and assume that you already know the factors (and weighting) that impact adherence for your brand. Once you have the factors, you should then ask yourself the following questions (In this order), before selecting an intervention:

    1. What is the desired behavior change I’m looking for?
    2. What is my company’s ability to influence this behavior directly given my known constraints?
    3. What is the key messaging point that I could deliver?
    4. How likely is that message point to stimulate the desired behavior change?
    5. How would I measure the change (i.e., metric)?
    6. Is there some other party that could more effectively address the desired behavior?

    We have worked with our clients to literally line up the answers to these questions against the factors driving non-adherence in an Excel model to quickly identify the optimal set of adherence-enhancing interventions for their brands.

    Not sure where to start? I’m happy to help.

    Adherence… A Two-Sided Equation

    September 15, 2011

    When you’re thinking about adherence related to your brand, are you solely focused on what you can do to help patients be more compliant and persistent with their therapy? Well, if you are, you could be missing a really significant contributor to non-adherence—prescribers.

    I know what you’re thinking… Doctors want their patients to take all of their medication, so how can they be contributing to non-adherence? Well, research shows that doctors can impede adherence through a number of means.

    The first, and perhaps one of the more well known of these, is ineffective patient expectation setting. Most of the time, HCPs don’t do a great job of letting patients know what they can expect from their treatment. It’s especially poor when the patient has been treated for the same condition previously. Doctors may not talk about side effects because they fear they will scare the patients away from treatment. They don’t really talk about benefits because they worry about making promises related to efficacy. And, they don’t talk about how the drug works because they think patients don’t care or would not understand. You can see where this is going, right?

    Patients are often leaving their doctor with a prescription, but with limited understanding as to why they are taking it. And patients who aren’t able to attach a value proposition to their brand are much less likely to remain adherent. What’s their reason to believe?

    A lesser-known contributor to non-adherence by prescribers is that they often don’t reinforce the importance of medication adherence with patients. It turns out that many physicians actually give patients permission to skip doses when it comes to taking their medicines—noting that if they miss some doses it’s OK and unlikely to have an impact on their outcome. Furthermore, physicians have reported that they do not like to confront their patients about adherence because they feel it undermines the trust in their relationship. If doctors aren’t going to demand full adherence from patients, how can we expect that patients will strive for it themselves?

    So when you’re thinking about adherence related to your drug, be sure you put your prescribers under the microscope as well. What you find there might surprise you and can drastically impact how you invest dollars to improve your brand’s duration of use.

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