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Atlantis Healthcare’s Aunia Grogan on the challenges facing pharma’s efforts to address the medicines non-adherence epidemic

By Aunia Grogan on Mar 14, 2012

Over the last few years, pharma has been investing significant resources into improving adherence to medicines among patients. This development has largely been driven by the industry undergoing fundamental changes as it hits the patent cliff and pipelines dry up. These changes have consequently forced reappraisals of business models and considerations of other revenue streams that haven’t been taken seriously before.

Enormous pressure is being placed on pharma to deliver evidence of value versus other (often cheaper) alternatives. It is increasingly difficult to command a premium for a therapy based solely on clinical efficacy. There is also growing demand for ‘real world’ data demonstrating superior outcomes for patients, which brings the challenges of non-adherence into sharp focus.

A strong case for adherence support has arisen now that health systems are more aware of the financial impact of non-adherence. Health systems are becoming increasingly sophisticated in their use of data and health economics to track and allocate resource, and non-adherence is now recognized as extremely costly to both these systems and to patient wellbeing. (For more on health economics, see Health economics data and market access.)

For example, in the United Kingdom, the NHS is expected to deliver efficiency challenges of £120 billion. Investing in adherence reduces wastage in medical spending while also ensuring treatments provide optimal value for patients.    

There are three significant hurdles to overcome to achieve better adherence, and these hurdles are consistent regardless of location.

Enrolment in patient support programs

How do we access the patients who will benefit most and encourage them to join programs? Access to patients is an issue across the US and Europe. Getting the right patients onto support programs requires close collaboration with healthcare professionals (HCPs) who have a one-on-one relationship with patients. Ensuring these clinicians are motivated to get a patient enrolled is crucial. But as we know, HCPs are busy people and if they don’t see the value and benefits of getting their patient onto a support program they will prioritize other issues during consultations.  

Suspicion

Given that most patient support programs are sponsored by pharma, rightly or wrongly, there is a high level of suspicion from HCPs around the motives of pharma. Pharma needs to respond to this issue head on. Do they hope to benefit commercially from encouraging adherence? Yes, absolutely.  But that doesn’t mean that adherence isn’t good for patients and health systems. That is the point that often gets missed; pharma benefiting shouldn’t necessarily mean that other people lose out. In fact, the most sustained solutions are where you can define a win, win, win for patients, health systems, and pharma.

Resistance to new approaches

There is reluctance to try new things in pharma. This isn’t unique to adherence; any innovative approach or technology generally comes up against this issue. And it is a very real barrier for ‘Big Pharma’. The implication is that we need to take out some of the risk of trying new approaches. With a focus on adherence, in order to achieve this, solutions must be based on evidence and be completely transparent about the capabilities of the program. In my experience, the single most important success factor here is ensuring you have a senior champion who will endorse a program and encourage and/or mandate people in their organization to get involved.

Future developments

Technological innovations offer new opportunities to tackle non-adherence issues all the time, especially for non-intentional non-adherence. But I believe that changes in how we use technology will be of equal or greater importance. How we interact with the world around us is evolving, by the hour it seems, and this offers huge opportunities.  

We have only really scratched the surface of using social networks to support patients. And the potential to create programs for patients across all of their medications then connecting this to their health records (thus, outcomes) is a very real possibility in the near term. I feel this is the single biggest opportunity: more genuinely personalized programs integrating disease management (medication, diet, and exercise) for an individual patient across all their conditions as well as between patients and their HCPs. (For more on patients and social networks, see Special report: Pharma and social media.)

Social media is another dynamic channel to connect patients with support, but there are tremendous challenges around data privacy and liability and, unfortunately, once people become aware of that there is a tendency to back away from those solutions. Longer term, social media offers the potential to deliver integrated personal support for patients their families and, where appropriate, better links to their HCPs.

Aunia Grogan, previously director of adherence at Novartis Ag, is director of Europe and Middle East for Atlantis Healthcare. She will be presenting at the Patient Summit Europe on May 29-30 in London.

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