The pursuit of persistenceTo say that tackling patient compliance and persistence poses a challenge to the pharmaceutical industry is like calling Tiger Woods a competent golfer or describing Katrina as a particularly bad storm. It is a gross understatement.
Persuading patients to fill every prescription and follow treatment regimes to the letter seems almost as daunting as eliminating our dependence on foreign oil, reversing global warming or finding some sort of peaceful solution in the Middle East. Marketers believe there is an answer, but have yet to execute anything on a scale big enough to move the needle.
And so companies continue to pump resources into researching and analyzing why patients stop taking medicines. Attention in the last few years has centered on patient-physician interaction, in particular on empowering the consumer with the info to ask the right questions in the exam room. More recently, emphasis shifted to the doctor to ask the patient better questions, use more appropriate language and help them truly understand their condition and why they must continue to follow a prescribed course of treatment. None of this is news to pharma marketers, of course.
However, one interesting angle that I've heard discussed a couple of times recently in the context of patient compliance is the effect of free samples. In this month's roundtable on point-of-care (p.48), Mike Boken, senior product director for Shire's ADHD treatment Vyvanse, explains that because his drug is a controlled substance, it cannot be given away, and instead patients receive starter cards with a CD-ROM and an information pack. To activate the card, patients must opt into the CRM program, which, he says, 95% of them do.
Boken describes the pack as a “big opportunity to explain the ‘why,'” and sees it as a key tool to fight non-compliance. But he is concerned that the majority of non-controlled drugs are missing out.
More than just missing out, samples may actually be having a negative impact on persistence, according to one particular session at last month's Pharmaceutical Marketing Research Group Institute in Philadelphia.
Andy Stautberg, brand insight director for Crestor at AstraZeneca, along with his marketing research partners from Marketing Technology Solutions and Verispan, presented data showing not only the positive effect of better physician-patient dialogue on persistence, but also that those patients given the most free samples (for the longest duration) record the lowest number of subsequent filled scripts. In other words, the data implies they may be the least persistent group.
In some ways, these findings seem counterintuitive. Why would a patient who is started on samples be more likely to stop taking a drug thereafter? Is it because they receive less information about the condition and/or treatment? Is there a propensity for doctors to skimp on the quality dialogue when they hand out free pills? Boken believes samples have a significant effect, and says he is “fortunate” that Shire's ADHD medications are controlled substances.
There are, of course, many other factors at play, both known and unknown. Stautberg also pointed out that the most-sampled group of patients also contained the highest proportion of uninsured.
One thing's for sure, I do not envy those of you tasked with solving the patient-compliance puzzle. However, I might have a couple of ideas on global warming…