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March 28, 2017 admin0


While the primary focus of patient adherence programs today has shifted from the product to the patient, the communication barriers that hinder patient interaction and engagement are still common. Many of these barriers can be overcome by investigating and addressing the root causes of issues, which often occur in either the basic program design and/or within technology systems.

This article looks at three common obstacles and how they can be addressed in order to improve communications, and as a result, improve the adherence rates and outcomes of your programs.

The Obstacle: Patients lack interest in participating, or the program does not allow for patient interaction.
The Solution: Design a program that emphasizes empowerment and two-way communication.

A basic principle to keep in mind when considering the communications modes of your programs is that patients do not want to be “compliant,” they want to be empowered. The more that patients understand why they need to take a specific medication in a timely and consistent manner, or how they will benefit from participating in a treatment regimen, the more likely they will become fully invested in the process to reach a desired end goal. Poor communication often results in patients who don’t feel that they program reflects their needs, concerns, and interests. Enabling for two-way communication is crucial — that means allowing ample opportunities and channels for feedback, and tailored resources to be shared at the right time throughout the entire course of the program.

The Obstacle: Communication with the patient is “one size fits all.”
The Solution: Allow for interactions that are flexible and relevant.

Many factors come into play in the communications of adherence programs: the channel (phone call, text, online chat, etc.), the frequency, the topics discussed. But all too often these communications are designed with solely the general group patient profile in mind. While overarching information about the patient profile is important, it needs to be married with the flexibility of individual experiences and preferences. There are many factors that influence patient behavior — age, gender, family, socio-economic, financial, and logistical — and each of these adapts the patient journey. For example, a more responsive model could mean stratifying patients by level of risk and adjusting the information provided, and the frequency of contact, depending on the needs of the patient at that particular moment. Interactions need to adapt to the patient, not just the patient population.

The Obstacle: Communication systems are siloed — they inaccurately portray a straight narrative, and lack the necessary insight into the entire patient journey.
The Solution: Leverage new technology to assist in program coordination and tracking.

Technology is critical in adopting an adaptive approach to patient communications, but it needs to be orchestrated and adaptive. Taking advantage of a system that synchronizes with the ups and downs of a patient’s journey can help manage variation and provide guidance and insights through intelligence and integrated analytics. Far too long, systems have been focused on single business models or functional areas. This hinders patient communications by creating a fragmented customer journey. As programs become patient-centric and holistic, the technology should follow suit. A platform that allows for evolving interactions with a patient can present a big-picture perspective, and through continuous sensing and orchestration, offer real-time insights and assist with decision-making.

While it’s true that the most effective patient adherence programs keep patient engagement at the heart of their programs, that’s no longer sufficient as a stand-alone element. Considering what patient-centricity really means in terms of communications — and how technology can make a difference — will allow for adherence programs to adapt and improve in real-time, and help further their goal of improving patient outcomes.

Pega Decision Hub Patient and HCP JourneyDiagram, courtesy of Pegasystems, illustrates how patient communications across all channels meet in one hub, combined with the ongoing communications with healthcare providers. In this article, the challenges to patient communications are in focus.



Ed_ChaseEd Chase is the director of Life Sciences Solutions at Pegasystems, where he manages the strategy, design, development and marketing of enterprise software products and solutions. He has spent more than 20 years in the software industry, with the majority of those in life sciences, covering both R&D and Commercial solutions. Ed brings a deep technology background that includes product management and development for enterprise applications, business process automation, imaging and electronic documents, and information assurance and authentication. Currently he leads the Patient-Centric strategy, marketing and product development for Pega’s life sciences applications. He can be contacted via email at

Susan Mattson_BW-webSusan Mattson has more than 25 years of management experience in the pharmaceutical, healthcare and education industries. She has owned her own business development and marketing firm and has served as the director of public relations for a major hospital, with responsibility for marketing, public affairs, community health and development.  She was also previously the assistant vice president of public relations and marketing for a major university. She began her career as a U.S. Naval Officer in public affairs. Susan currently serves as a senior director in account management for programs at C3i Healthcare Connections, with oversight of several patient engagement, access and reimbursement programs and business process outsourcing programs. She can be contacted via email at


For more about these companies, follow C3i Healthcare Connectionson on Twitter @C3iHC, or follow Pega @pega.

March 24, 2017 Bob Ehrlich0

We all know about patient support forums. I am sure most of us check one forum or another about a condition we or a loved one have. Only recently did I have an occasion to see how powerful patient to patient sites are in influencing treatment and thought about how important it is to integrate DTC strategies with these groups.

My story involves the male nemesis called the prostate. At my advancing age I get tested annually for PSA levels which have been rising the last few years to a borderline level. My internist was reassuring but suggested that I can see a urologist if I felt concerned. I like to be a well versed patient so the research began which led me to read everything on high PSA levels. I found much information on how so many men get unnecessary treatment which starts with high PSA levels to needle biopsy to removal of the gland. Many of those men have lifelong urinary incontinence and erectile dysfunction from treatment for something that would never have killed them had it been left alone.

Bob Ehrlich
“Powerful patient to patient sites are influencing treatment.”
-Bob Ehrlich

I also found new methods to further evaluate high PSA levels without a biopsy. The patient forum approach led me to find these alternatives and the leading edge providers. I discovered that urologists do what they know best and that is recommend an often painful biopsy which is a random sampling of tissue. Armed with alternatives such as a Multiparameter MRI I visited the said urologist. After checking my urine stream with an ultrasound which was fine and had nothing to do with my complaint, he recommended a biopsy. Now this was before he even examined me. No way I replied would I do a blind biopsy without an MRI first. He said those are inaccurate but my research and forum buddies led me to the latest findings which showed they are much more accurate than a blind biopsy.

So I finally cajoled the MRI script from the urologist. I then used these patient forums to find an expert who specializes in reading prostate MRI images. I found one a few hours drive and went. I also saw that insurance would not cover it so I shopped around. The self pay quotes varied from $695 to $2500. Sometimes you get what you pay for but it turned out the lower price provider was the best.

My result was that there was nothing to biopsy and my PSA was rising along with the size of the gland. Long story but the lesson learned is patients talking to patients saved me 12 needle shots to my little walnut sized prostate gland and potential infection. By the way those biopsies miss 30% of actual cancers because they sample only 1% of the tissue. The MRI catches 93% of any significant cancer. Since the percent of men who have microscopic cancer in the prostate is equal to their age, you do not want to find those tiny indolent cancers that will never do you harm.

Doctors probably hate patients like me who read medical journals and discuss options with other patients. Too bad. This is the future of medicine particularly as we self fund our treatments more and more. The idea that doctors and patients have a strong bond of trust is declining. I trust my primary care doctor but have a lot less faith in the specialists who do what they know how to do.

How should drug companies interact with patients on these sites? Given regulatory issues it may be difficult to actively participate. Certainly by monitoring them, however, you learn so much about patient concerns, and how they talk about their issues. At least it gives you a good feel how to develop the right approach to discuss your drug with them. I know providers actively engage and respond to misconceptions about treatments and side effects. So doctors and patients do interact on these sites.

In my case I have become a fan of the patient to patient sites and now help others in my same position. Doctor, get ready for the super patient who takes charge of their care because that is your future.

March 17, 2017 Bob Ehrlich0

The final 2016 spending was released recently showing $5.66 billion versus $5.18 in 2015. DTC Perspectives has received some detail on these numbers and we ran some analysis explaining the growth. In 2014 spending was $4.33 billion so the last two years has seen growth of 31%. The 2016 number was a record and we expect $6.0 billion to be reached in 2017.

DTC spending has grown historically when new brands launched DTC programs.  That certainly happened in 2016. Total spending rose about $500 million in 2016. That rise can be largely explained by new brand spending. There were 12 new brands that launched significant DTC efforts in 2016 accounting for about $730 million in media. That is about 13% of the total. There were some huge spenders among new brands. Cosentyx, Entresto, Rexulti, Taltz, Tresiba, Viberzi, Trintellix, and Entyvio all spent more than $50 million in their launch year.

Bob Ehrlich
“The 2016 number was a record and we expect $6 2017.”
-Bob Ehrlich

Adding to the new brands were brands in their second year adding to their spending. Trulicity and Breo Ellipta each added over $100 million to their 2015 total. Adding new brands and newer brands increasing spending resulted in an increase of over $1.2 billion versus 2015. With a net rise of $500 million that means some brands must have reduced or cut spending entirely.

Several key spenders withdrew entirely from DTC advertising. Tanzeum, Auvi Q, Spiriva, Duavee, Levemir and Afrezza withdrew entirely accounting for $210 million in reduced media. Large cuts in budgets were seen in Cialis, Latuda, Jublia, Onexton, Belsomra, Crestor, Anoro Ellipta, Kerydin, and Osphena. These cuts reduced spending by $500 million.

There is a diverse portfolio of brands advertising. There are 58 brands with significant budgets of more than $25 million. The top 20 brands dominated and spent 55% of total media. While most DTC brands do both television and print there are many that have small budgets used for print, point of care and internet. There are 84 brands with budgets large enough to do at least print and some targeted web and point of care.

On a company basis Pfizer is the dominant spender at $1.2 billion up about 10%. Notable was Novartis spending $250 million up from less than a million in 2015 from new entries Entresto and Cosentyx. Diabetes drug Trulicity gave Lilly a 40% rise. Opdivo powered BMS to a 15% rise in spending.

We do not have the data yet on splits by media type but sources tell us that there is no significant change in the share by medium. That means television remains dominant and no major brand launches a DTC effort without using television as a large share of the media plan. Nielsen does not report on point of care but the industry remains a growth driver.

March 13, 2017 Bob Ehrlich0

While we are seeing record $ 5.6 billion spending numbers for DTC for 2016, we are also seeing a populist tide raging against drug companies. At the upcoming DTC National a few weeks from now we will be spending a lot of time on the forces that may affect the health of DTC in the future.

Most of us practicing the art and science of DTC have no control over political decisions on drug pricing and drug approval. That being said, it is imperative DTC marketers understand the popular sentiment consumers are exhibiting towards drug companies. The Trump movement and the Democrats are aligned in the rage against drug prices. The two sides rarely agree on anything but here they are of one mind.

Bob Ehrlich
“Every brand… must understand consumer reaction to drug prices…”
-Bob Ehrlich

The presentations we are planning on DTC are not theoretical exercises. Our goal is to educate the DTC community on what you can do to make advertising decisions in the context of this populist movement. We need to read the tea leaves that pricey drugs must be cost justified versus the cheaper alternatives. While few DTC ads address price, we all know that eventually consumers may react with sticker shock when they take their script in to be filled. We must recognize as marketers that every DTC program needs to have an element that addresses price/value.

That element may not necessarily be part of a mass media campaign because it is a complex discussion. Somewhere in the consumer campaign, however, drug companies need to discuss price. Maybe every web site needs a section on price justification. While most drug companies work the coverage angle only with payers, consumers are going to increasingly be partial payers of drug bills.

While the industry does campaigns to portray its research efforts, political forces instead focus on price versus other developed countries. I am afraid this issue is at a tipping point and DTC marketers need to figure out how to deal with it. Many price support programs are part of DTC ads, and that is a good step. Unfortunately, price subsidies address only part of the problem. Eventually, these drug company price support programs end after a year or so and then what?

I am not arguing that DTC television or print ads should directly discuss the drug price. I am, however, advocating that every brand team must understand consumer reaction to drug prices and anticipate how their DTC affects the perception of price/value. We must remember that consumers have no idea from a drug ad whether the cost is $2 a pill versus $2000. What other industry advertising its products is such a mystery to consumers? Consumers have a good feel what a car brand will cost, and they know the range of most advertised consumer goods. Drugs are different and sticker shock is likely for many new advertised drugs.

Most drug DTC marketers have no involvement in pricing their drugs. That is a top management call. What we can do is study the impact of price on consumers and try to study their attitudes in the context of proposed DTC ads. Does our ad get differing reactions based on the price pre and post consumers being told the price? Would their reactions change our creative approach? One thing is certain is that Trumpcare will not forget about lowering drug prices. That is a new reality drug makers will have to adapt to, and DTC programs will need to address it as well.

March 9, 2017 Bob Ehrlich0

Every year I seem to need to rebut a critic of DTC who proposes a ban. Google DTC advertising and every month there will be call for a ban in the media. These DTC Hunters think that by making it extinct great things will happen. First, they believe prices for drugs would drop dramatically if only drug companies stopped buying expensive ads. Second, the DTC Hunters believe that by killing ads, doctors would prescribe what is best for patients without wasting time explaining the advertised drugs. Third, they believe that by keeping consumers unaware of new drugs, those good old fashioned generics would become more widely used thus lowering consumer and payer cost.

Bob Ehrlich
“DTC is not perfect but serves its role.”
-Bob Ehrlich

First let me admit drug ads are designed to sell more pills. The drug industry likes to say drug ads are meant to educate and they shy away from admitting they use DTC to increase sales. We all can agree that DTC is done only to grow the bottom line. So what? Prescription drugs are a good thing and promoting drug solutions should not embarrass drug companies. The Drug Hunters want to expose these evil folks for wanting to sell more of what they make.

So do DTC ads raise prices? That must be answered as maybe. If you mean, do branded drugs cost more than generic alternatives? Then, yes, DTC can raise drug spending. If a patient asks a doctor for a new drug that is no better than an old cheap alternative then I can agree. The reality is quite different in many cases. New drugs generally are improved from older versions or new drugs do not yet have any generic alternatives. I buy store brands if I believe they are equivalent. It is up to the drug maker to make their case to consumers to justify a branded premium. Consumers are not stupid and do not automatically assume this DTC drug is better.

Drug ads are in reality a small cost as a percentage of revenue. These multibillion dollar drugs spend $50-200 million annually. As a percent of sales that might be 2-5% so DTC costs is not a significant factor in drug pricing. Cutting ad spending will not cause drug companies to lower prices. In fact, that money would be redirected to physician promotion or to some other promotion. Since DTC increases sales, one would have to think banning it would reduce sales. Would we expect drug makers to cut prices if they saw sales decline from withdrawing DTC ads? The answer is no.

Let’s ask what would happen if consumers no longer saw DTC. Would physicians really spend more time with patients if they no longer were asked by pesky patients about new drugs? Would they now make their drug selection totally objectively? No. They would instead write drugs that they are used to using thus delaying adoption of new products. They would be detailed by drug reps, or be influenced by journal ads. They would be directed by insurance companies what their patients will get reimbursed on their drug bill.

Drug ads serve many positive purposes. Most importantly, consumers are getting information on what is available for their disease. They become more knowledgeable albeit imperfectly through DTC. They may not fully understand the drug’s pros and cons from the DTC but it is a start of a discussion. The ads incentivize doctors to stay current with new drugs because no doctor wants to appear uninformed with patients. The ads provide leverage to get covered by insurance companies who obviously would rather treat with cheaper generics.

Consumers understand that drug ads are designed to sell them on a product. They are not naïve in believing that the advertised drug is a wonder cure. They know there is wealth of additional information on pros and cons on the Internet. DTC is but one source of subjective information that balances what alternative constituencies are saying. Government payers, private insurers, consumer advocates, competing drug companies, and doctors all have an opinion on the value of the advertised drug. In this subjective world consumers face conflicting opinions. Taking away DTC will not lead to a utopia where patients always get the best drug from the benevolent payers and providers.

Advertising helps build competition. It promotes new products. We may not like it but we would not like a world where consumer choice is censored. DTC is not perfect but serves its role of letting consumers know what is available in a health care world where patients cannot assume objectivity from insurers or providers.