Direct Marketing: An Rx for Medication Non-Adherence, Part 2

Last month, I wrote about the fact that regardless of the condition for which a medication is prescribed, after three to four months, only about 40 to 50 percent of the people prescribed long-term medications are still taking them. Controlled testing has shown that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent. So why aren’t these techniques used more often?

healthcare marketing[Editor’s note: In a related matter, healthcare marketers are invited to discuss matters like these on June 15 at the Target Marketing Healthcare Roundtable. This link allows marketers to register.]

Last month, I wrote about the fact that regardless of the condition for which a medication is prescribed, after three to four months, only about 40 to 50 percent of the people prescribed long-term medications are still taking them. Controlled testing has shown that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent. So why aren’t these techniques used more often?

One of the biggest barriers to creating effective patient intervention programs is the speed with which they have to be implemented. Keep in mind that 20 to 30 percent of prescriptions are never filled, and 40 to 50 percent are not taken as prescribed, according to the National Council on Patient Information and Education. (Opens as a PDF) As a result, the closer to the point of prescribing that patient interventions begin, the more successful they will be. If the interventions don’t start until three months after a prescription is written, a significant portion of the patient population is already gone, and the patients who remain are those who are likely to remain persistent, anyway.

There are several reasons why people don’t take their medication as prescribed, but most important among them is the fact that people often do not understand why they are taking a particular medication or how long they’re supposed to take it.

Educating patients about how their medication works in simple language can go a long way to helping them realize how and why to take it. And while there are various stakeholders who can benefit from increased adherence, each has their own particular barriers to creating an effective program.

First, there are the pharmaceutical manufacturers. They’re constrained by the FDA regarding what they can say to the patient, not allowed to stray from the language in their approved labeling. Frequently, this constraint ends up with patients getting communications in language that they can’t understand. Additionally, brand managers may be reluctant to spend money from this year’s promotional budget to affect potential sales increases in future periods when they may have moved on to another assignment.

Pharmacies could potentially benefit from increased adherence; however, their margins on prescription drugs are too low to devote the resources necessary to deploy an effective patient education program. Their efforts are largely limited to refill reminders, which are not effective in increasing persistency. Forgetfulness affects compliance (taking medication as directed), but persistency (continuing to take medication over time) is driven more by the psychological factors I addressed last month.

Healthcare providers are constrained by the amount of time they have to spend with a patient and by the fact that the patients generally forget most of what they’re told during their 10 minutes with the provider before they even leave the office.

Those who have the most to gain are the insurers, the ones who pay the healthcare bills. Apart from the patients, these payers have the highest stakes in the game. Convincing a patient to take cholesterol and blood pressure medications is a lot cheaper that paying for the hospitalization costs associated with a cardiac event. And while the insurer, (for example, Aetna) may know that a patient was diagnosed with a particular condition, it’s the PBM, pharmacy benefits manager, (for example, Express Scripts) who knows if a medication was dispensed and when. These are important data points for creating effective patient interventions, because the sooner you get to the patients, the more patients you can affect. But the PBM can’t account for the 20 to 30 percent of prescriptions that are written and never filled.

The most effective interventions start with incenting patients at the time that their initial prescription is written: specifically, giving them a free initial supply of medication for providing their contact information. That data capture lays the groundwork for early intervention. From there, a data sharing partnership between the payers and the PBMs can provide the information to get the appropriate communications to patients at the right times. This type of partnership is a tall order, but as the New York Times reported in April — citing a study in the Annals of Internal Medicine:

“This lack of adherence, the Annals authors wrote, is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.” (Opens as a PDF)

The various stakeholders need to come together to improve this situation.

Direct Marketing: An Rx for Medication Non-Adherence

Direct-to-patient communications are an effective tool for overcoming barriers to adherence. Educating patients about how their medication works in simple language can go a long way to helping them realize how and why to take it.

healthcare marketingCiting a review in the prestigious Annals of Internal Medicine, the New York Times recently reported that people do not take their medication as prescribed. “This lack of adherence is estimated to cause 125,000 deaths, and at least 10 percent of hospitalizations, and to cost the American healthcare system between $100 billion and $289 billion a year.”

This news was not surprising to me. I know from professional experience that many prescriptions are never filled (20 to 30 percent according to the article), and that regardless of the condition for which the medication is prescribed, after three months only about 40 to 50 percent of those prescribed long-term medications are still taking them. I also know from controlled testing that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent.

There are many reasons why people don’t take their medication. Forgetfulness is not significant among them. So medication calendars, special pill bottle caps and refrigerator magnets can have only a marginal effect. Refill reminders from pharmacies and Rx brands are not effective, because the most significant reasons for non-adherence are psychological:

  • Medications remind people that they are sick, or have a medical condition; many people would rather ignore or deny that. They see taking medications as a sign of weakness.
  • Medications are viewed by some as chemicals that are bad for the body in contrast to “natural” remedies, like fish oil or vitamins.
  • Medications for silent conditions, like high blood pressure or high cholesterol, don’t make people feel any different. So they see no benefit in taking them.
  • Many times people do not understand why they are taking a particular medication or how long they’re supposed to take it. Doctors do not have the time to adequately explain it. The standard physician visit is scheduled for 15 minutes, and according to another Annals of Internal Medicine study cited by Forbes, “even when in the examination room with patients, doctors were spending only 52.9 percent of the time talking to or examining the patients and 37 percent doing paperwork. In other words, shrink that 15 minutes to under eight minutes.”

Direct-to-patient communications are an effective tool for overcoming these barriers to adherence. Educating patients about how their medication works in simple language can go a long way to helping them realize how and why to take it. The stakes are high, and the stakeholders who stand to benefit most from increased adherence (besides the patients themselves) are insurers, healthcare providers, pharmacies, and pharmaceutical manufacturers. Each of the stakeholders has their own roadblocks for mounting an effective program, which I’ll explore in a future post.