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The Role of Dose Titration in Medication Adherence

Tags: Adherence

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

Tags: Adherence

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

Tags: Adherence

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.

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