Snapshots of Adherence: Three Big Pharma Strategies

Here's a look at how three of the biggest pharma companies are trying to address medication non-adherence, with Script Your Future and beyond.

GlaxoSmithKline

GlaxoSmithKline started a new team – Patient Engagement – in March. "We want to really understand the patient beyond the disease, beyond the medicine that they're taking, really understand everything else that's going," says the team's lead, Chris Preti. "And then from that understanding develop potential new solutions going beyond adherence to improve our overall engagement with that patient."

In the same month, GSK launched a Community Pharmacy Team – liaisons who provide information and tools to help pharmacists communicate with patients on optimal disease management.

The company also has respiratory care educators in its respiratory groups. "These are clinical liaisons that actually work with the providers around the objective of optimal management of COPD and asthma therapy," Preti says. "Again, it's management of these diseases from a holistic perspective."

In its payer organization, GSK has a Care Management Team to provide chronic-disease-based education to payers and employer groups. One example of this is "Health Coach For Me," a website based on quality measures to educate patients.

Finally, GSK has advocacy alliance teams, which includes coordinating on Script Your Future but also work with patient advocacy organizations such as the COPD Foundation or Asthma Foundation.

Preti says GSK has found that patients are looking for help navigating through changes, for customization, and for simplification. "It's not a lack of information out there, it's just that information reaching the patient at the right time and is it the right solution and is it provided by the right individual."

Preti also acknowledges that the problem is complex because it's about behavioral change that's oftentimes not pleasurable – and benefits are not realized until later.

So, Preti says, one key element is "understanding that whole healthcare journey that the patient goes through to identify what are those helpful and unhelpful factors. But even beyond that, what else is going on in their lives such that perhaps there might be an innovative solution that we can partner with somebody to meet that need. Or that we could introduce something beyond even the pill."

GSK became involved with Script Your Future because the mission directly correlates to GSK's mission around improving long-term patient outcomes, Preti says. The company is involved with financial support, working group participation and grassroots efforts.

Preti notes that one of the six focus cities is Raleigh, NC – near GSK's US headquarters. "So making sure our call center is prepared, internally announcing some of the efforts and some of the mission from the Script Your Future campaign. Our employees can be ambassadors from the grassroots level."

"From our perspective, it's a win-win for all customers involved, whether it's industry, whether it's government, whether it's the payer, or whether it's the provider, because at the end of the day, it's all about trying to improve outcomes, lower the healthcare costs, and then improve resources around this space of adherence," Preti says.

Merck

Merck has been involved in adherence research and interventions for years, but has started focusing on the research in a different way. "I think the company just believed that addressing the problem would be good for patients, would be good for payers, and would also be good for Merck," says Executive Director of U.S. Outcomes Research Newell McElwee.

"Historically most of the efforts for pharmaceutical companies, Merck included, have been on making sure that initial prescription was written," he says. "But if you don't take some accountability in looking at what happens after that, then patients don't get the full benefit of the medicine and Merck loses potential revenue from patients taking their medicine. So I think there are a lot of reasons to sort of re-think the historical model of just thinking about their first prescription."

One part of this new focus was an organizing framework ("proximal-distal continuum") created a few years ago by Senior Director for U.S. Outcomes Research Colleen McHorney. It "basically suggested that the variables that are closest to the patient and closest to the medication are stronger predictors than things that are much further away from either the patient or the medication, like demographic characteristics."

Merck tested that idea and it is now the "conceptual underpinning" of work on a predictive tool Merck calls the adherence estimator. "We had a whole bunch of variables, we had a conceptual framework, and then we studied them cross-sectionally to see what the best predictors were," McElwee says. "The strongest predictors were the ones that were closest to the patient and closest to what their medication beliefs were. And those are the three questions that are on the adherence estimator."

The questions are: How could this medication affect me? Why should I take this medication? and Will I be able to afford this medication over time?

Merck has been testing tailored intervention messages based on the estimator responses in a lab with George Mason University. Now it is taking that to real-world setting – specifically using pharmacists to deliver the message. They're also interested in looking at physicians, nurse practitioners – even barbers or ministers. Additionally, the estimator research is public, and Merck has heard anecdotally that there are 75 groups using it.

McHorney has also shared the estimator research with Script Your Future. Merck recently became involved in the campaign through its acquisition of Schering Plough, one of the original participants.

Merck has also learned that patients can be very compliant on some medications and non-adherent on others. "You can't have a one-size fits all intervention," McElwee says. "It's got to be specific to the medicine and the patient's belief about that particular medicine."

There seems to be a difference between asymptomatic chronic diseases and symptomatic ones, for example. "You may be able to lump diabetes and congestive heart failure together, but not arthritis and asthma," he says. "They're kind of episodic diseases, and I think that the way that patients think about medications in those diseases may be just a little bit different."

"Even the adherence estimator was developed based on six chronic diseases, and we sort of lump them together, but if you sort of tease out looking at subgroups, the performance among each of those six diseases, that's where we started to see the clumping," McElwee says. "So that really needs to be confirmed in other studies."

Merck has studied value-based insurance benefit designs and disease management programs, looking at diabetes medication possession ratios. "Value-Based Insurance Plus Disease Management Increased Medication Use and Produced Savings" was published in the January 2011 Health Affairs issue "Accountable Care Organizations: Making Them Work." Merck also recently presented data on stages of non-persistence, survey non-responses, and the relationship between unintentional and intentional non-adherence.

"There are a lot of very smart people that have tried to figure out how to improve adherence and most of them have not really been successful. So this is just an incredibly complicated area," says McElwee. "Our department has been working for the past four years just doing research in the area, and it seems like the more we learn, the more questions we have."

Pfizer

Pfizer believes it has an obligation to work on adherence, given the high health and financial impact.

"As the largest pharmaceutical company in the world, it is our responsibility to ensure patients can enjoy the clinical benefits of taking their medication, while at the same time we can assist with reducing unnecessary waste in the system," Pfizer said in an email. "Improved medication adherence benefits everyone within the healthcare system: it makes it less challenging for physicians to manage disease, improves outcomes for patients and lowers cost for the healthcare system."

Pfizer cites its "Get Quit" program for Chantix as an example of a "highly customized" program. "Upon signing up, patients answer questions about how they like to receive information, why they smoke, when they smoke, and their reasons for quitting," the company said. "The program provides them with customized messages and activities, specifically designed to help them quit. They also receive support from a Mayo Clinic-certified tobacco treatment specialist who counsels them on how to overcome the challenges of quitting."

Additionally, the company has outcomes research efforts underway to look at the impact of non-adherence with real-world data. Pfizer also has "extensive outcomes research efforts" underway to use real-world data to look at the impact of non-adherence.

Pfizer also has multiple programs using providers to support adherence. One example is "My Heartwise Great Starts Program" which providers can use to help patients manage their cholesterol. "This program has demonstrated a statistically significant increase in the number of patients who report taking their medication regularly as directed," the company said, citing self-reported data from an April 2010 Harris Interactive Market Research Readout of 120 patients.

The company also offers live counseling with a pharmacist, which the company says has been effective. "In general, the more successful interventions offer more customized interventions tailored to address the patient's unique needs and challenges."

Pfizer has been a committed partner of Script Your Future since the planning began in February 2009 and is active in all three working group: Healthcare Professional, Chronic Conditions, and Evaluations. The company has also contributed financially and will partner with NCL to identify local collaboration opportunities.