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April 15, 2015 Robert Nauman

In last month’s edition of the DTC Perspectives’ DTC in Focus newsletter, we discussed patient engagement and provided prescriptive thoughts on maintaining and even increasing patient commitment. This month, we take that thought one-step further (as well as, adhere to this month’s theme) and focus on patient adherence. The discussion includes whether the emphasis of such programs should be on both long and short-term medication adherence particularly in how they are resourced and measured.

A situational review

  • Current support programs typically devote a large amount of time and money ensuring patients initiate therapy. However, these programs never allocate time or funding to safeguard that the patient maintains adherence after that time period.
    • Studies indicate that patients with chronic diseases may not either grasp the severity of their condition; understand the literature they receive about their condition; or require multifaceted efforts to achieve adherence.[1]
    • Current support programs operate in silos. While these programs are typically mapped out strategically, they are not executed in a coordinated fashion.
      • These silos execute patient adherence programs:
        • Ad agency
        • PAP vendor
        • Co-pay card company
        • Reimbursement and benefits investigation vendor
        • Specialty pharmacy
        • Technology companies
        • Consumers, patients, and caregivers often are not satisfied with the content and creative contained in patient adherence programs
          • These targets at some point in the treatment process stop at All find the information initially helpful, but tend to look somewhere else for information because the information they want or need is not in the adherence program.
          • Patient adherence programs today are like an inverted hourglass. The strategy is thin at the top, disparate and expansive in the middle due to the silo construct, and then the program strategy attempts to narrow again. Yet, often this does not occur.
          • While all pharma brands say they have patient adherence programs, the reality is – and I am basing this information on my 20 years of experience – very few deeply engage and build a relationship with the patient; maybe 10% to 15% really execute this well. These programs work because senior leadership is committed to them for the long term, both in human and financial capital. (See last month’s column re: Biogen Idec.)

Operational issues still exist today

Along with the barriers already mentioned to pharma’s delivering quality adherence programs, there are two more barriers, and they are formidable.

First, product managers are no longer brand champions. Their roles now resemble those of purchasing procurement agents who buy a single program; their sole hope is to get noticed by senior leaders.

The second, arguably more significant complication is the FDA, namely its regulations. Companies have allowed their legal and regulatory teams to make business decisions regarding programs that minimize risk in terms of providing the evidence and content that patients and healthcare professionals want. The pejorative natures of today’s drug marketing regulations are designed to educate, not inform. Grant Corbett, a psychologist we have worked with says pharma produces content from the perspective that patients and others affected by disease are not competent to understand the information so brand programs need to “educate them.”[2] He asserts companies should make the opposite assumption and assume the patient, caregiver and consumer understand their condition and work to provide information that fills in the knowledge gaps. This is where great programs in the marketplace are focusing their efforts today.

Answers exist today

The short-term lead generation and conversion marketing strategies of patient adherence programs are no longer viable. The key to winning at the ground level is to have the program’s patient advocate be part of the solution that has been prescribed. It is paramount to ground a multi-channeled adherence program in a scientifically validated model to instill confidence in patient and caregiver. Patients and their care team need to believe they have the complete and long-term support needed to overcome their disease. Moreover, to accomplish this, the program needs resource and execution in a coordinated fashion. These are the factors creating a real competitive advantage in adherence programs today!

While industry spends $10s of millions on various aspects of the entire effort, that resource is cut up into smaller chunks or pools of money. This causes all parties to fight for their chunk of the pie and to lose interest with the whole strategy. Senior leaders, in this age of consolidation of resources, must consider these programs at a total cost level and ensure they all are driving value. That is why we advocate bringing back the role of a Brand Champion, an individual or set of individuals who commit to a longer-term career path with the brand, who can oversee the convergence and collapse of the silos – and decide how to spend the money.

Finally, we are big proponents of the net promoter score construct. Two or three simple questions added to any program to assess the patient’s willingness to recommend a product to a family member or friend. This simple measure helps leadership teams stay focused on the end goal of customer satisfaction, regardless of the program’s timeframe.


  2. Grant Corbett, Behavior Change Solutions.

March 18, 2015 Robert Nauman

The goal of any support program should answer this question: What factors must we use in the program that will instill patient confidence in our product – and by default our company? Trust is built by a series of actions and those actions speak volumes more than any words or discount prices ever can! A recent article in eMarketer reported seniors do not trust pharmaceutical company sites and prefer WebMD more.  In this work, companies need to be brave and work harder to deliver a better “patient experience,” while a patient is “on the product.”

A situational review

  • Patients do not want a relationship with a product; they want an “experience.”
  • Federal regulations tend to inhibit innovation in these pharmaceutical support programs.
  • The pharma industry’s patient support programs, in terms of the information they provide, are not valued as they once were. So many other avenues are available, and considered more trustworthy, to patients to get information, including the Internet and patient advocate groups. Maybe it is time to give Regulatory and the other legal protectors some new assignments.
  • Competitive pricing could force excellent programs to be marginalized and undifferentiated (i.e. Gilead and Abbvie in hepatitis C).
  • Patient Engagement is the hot new topic. Not only is pharma trying to come up with a viable, profitable formula for PE, but the Accountable Care Act is forcing many ACOs, integrated delivery networks, and other health care delivery system to tackle this issue as well. With so many different health care systems putting their unique spin to the issue, other questions arise: what works, what does not, how to separate the good from the bad? Think mobile app development.
  • The industry has examples of good and bad pilots. When programs scale to larger patient populations, they lose their patient focus. Outside of specialty drugs, physicians will choose DTC efforts over patient support programs as a factor influencing prescription recommendations.

The first problem is inherent in the program itself: Not all are ground in proven theoretical based methodologies that assist with a patient’s needs. In our opinion, the way to connect and engage is remove the current program silos. Commercial organizations need to consolidate approaches, converge vendors, look to execute more than innovate, and, most importantly, measure and value engagement as much as they do reach and lead generation efforts. Senior leadership should consider looking at the total spend as many fail to ask if all those dollars being spent can be focused more effectively to deliver better program execution.

It has been done before

We frequently mention the work! Biogen Idec demonstrated this with its MS drugs (Avonex & Tysabri) in the in the late 90’s to early 2000’s. Its focus was execution excellence and customer support. The call center and customer relationship management approach acted as the quarterback of its patient focused efforts. Its current website says it handles 800,000 calls a year.

Patients wanted to know about what to expect on therapy, they wanted to know what side effects they would experience, especially with Tysbari’s known side effect, Progressive Multifocal Leukoencephalopathy ( PML). Because of the regulatory requirements, the company embraced this as an opportunity, not a burden, to disclose potential side effects. Moreover, in 2002, Biogen had to take these issues head on because of other products in the market and the high visible media reports on PML.

Back then, management felt it important to have an employee assigned to each patient or caregiver as the single point of contact and relationship steward. This required consolidation and coordination with the ad agency, PAP, HUB, Co-Pay Card, Reimbursement and Benefits investigation, specialty pharmacy and technology.

It’s not a stretch to say that, 13 years later, this plan is still literally paying off: To quote a recent Motley Fool: “Biogen Idec’s MS drugs include the billion-dollar blockbuster drugs Avonex, Tysabri, and Tecfidera, as well as the company’s newly launched Plegridy … Sales of Biogen Idec’s MS drugs increased 47% to $7.93 billion, and its total sales increased 40% to $9.7 billion last year.”

In conclusion, keep in mind these points:

  • Doing this right with patients will produce the brand’s best product advocates.
  • Switch the metric quantified! Measure and reward commercial and medical teams on the number of patients who get better on the therapy as a result of the product and support; not on how many new patient starts were achieved in the past week. Measure engagement, get engagement is what produces real results!
  • “What have you done to help a patient on our product today?” should be stuck on a post-it on every employee’s computer, laptop and iPad.

If the product works, produces outcomes, and patients can easily access information they want, this will help them. They will get started on therapy and realize the value of staying on therapy for the long term. Consider who saved Tysabri from a market recall.