The top 10 pharmaceutical companies spend more on marketing and sales than on R&D.1 They spend a similar amount on insurance company rebates to help ensure patient access to prescribed medications.2 Overall, a pharmaceutical company may spend twice as much getting the patient to the retail pharmacy counter as it spends on inventing and testing new drugs.
All of the science and commercial investment comes down to this one decision point. Will the patient walk away? Here’s what we know:
- As many as 30% of people fail to pick up their prescribed medications.
- Among those who do pick up that first prescription, as many as 30% stop taking their medicine within 30 days.
- Up to 60% stop taking their medicine within six months.3,4
So how can we determine what will get patients to stay and take advantages of the medicines that can improve their lives?
In our first annual Patient Adherence Influence Report, we set out to understand the most influential factors driving patient adherence or non-adherence and to answer the question: Will the patient cross the finish line at the retail pharmacy or will he or she walk away?
We leveraged extensive data from Adheris Health, a provider of patient performance programs with insight into over 2 billion prescriptions per year, to look at the top 100 most prescribed retail pharmacy branded drugs for chronic conditions across 20 different therapeutic categories. Then we identified over 200,000 “new-to-the-brand” patients – patients who filled a brand for the first time in the first quarter of 2016 – and followed them over the next nine months. We assessed their prescription utilization (re-fill behavior) against more than 30 product, patient, prescriber and payer variables to understand the most influential factors driving patient adherence or non-adherence, as measured by average patient days on therapy (PDOT) – that is, the number of days during the nine-month period when the patient had the prescription medication on hand.
We learned several important things about who these patients are and the factors that can combine to raise barriers to adherence.
“Female over 40” may be the single best description of the retail pharmacy patient in 2016. Over 60% of patients who filled a new prescription for a chronic brand at a retail pharmacy in 2016 were women and nearly half of these (48%) were over 40 years of age. As might be expected, retirement-age men and women (age 65 and older) made up another substantial proportion (38%) of all new-to-brand retail pharmacy patients.
But gender gaps persist. Overall, PDOT was about 5% higher for men than women. This is consistent with study findings that, despite their higher utilization of medications, women were overall less adherent than men -- and also showed poorer outcomes across all 25 clinical measures assessed.5 This may be due, in part, to women’s role as caregiver and tendency to place the healthcare needs of others above their own.
Older (and wiser?): age matters. A patient over the age of 65 consumed 23% more of the drug prescribed than a 35-year-old. One reason may be that younger adults often lead hectic, demanding lives (jobs, children, older parents, etc.) and the needs of other family members often take priority over self-care.6
Copays in context. A patient with a primary copay of $60 used about a third less medication than a patient with a smaller copay. But the single most important factor influencing PDOT was the copay as a share of the patient’s total copay expense – a problem particularly for patients with co-morbidities. When a patient had to pay three additional copays for other drugs, the brand lost a month of therapy.
At the stroke of a pen: the role of refills. While there are numerous reasons why a physician might not write refills (e.g., a need to closely monitor patient response to therapy before continuation), a drug with even just one authorized refill was associated with an increase in PDOT of 20 days -- doing as much for consumption as bringing the copay down to zero.
What Can Be Done?
This report, the first in an annual series, looked at health behaviors through a specific lens – patients’ prescription refill behavior at the retail pharmacy and the factors that influence medication adherence for chronic diseases. Our data suggest that it is important to take context into account when assessing adherence and ways to promote it, including the comorbidities a patient has, the number of prescriptions they are filling and the total cost burden they are facing. Beyond the question of copay, each of these factors plays an important role in how patients will answer the “to fill or not to fill” question at the retail pharmacy level.
Responsibility for linking treatment costs to clinical outcomes is increasingly being shared by patients, physicians, payers and the pharmaceutical industry alike. Whether through direct-to-patient communications,7,8 via interventions to encourage writing prescriptions with automatic refills,9 or by addressing other contextual issues that create barriers to adherence, improving medication persistence should be a shared objective of all entities involved in a patient’s journey.
To read the full report with analysis across all 30 variables surveyed, download the Patient Adherence Influence Report. Contact us to learn more about patient adherence and behavioral science solutions aimed at improving adherence.
Authors from INC Research/inVentiv Health
Director, Pricing & Market Access, at inVentiv Health Consulting
Director, Senior Data Scientist, Program & Quantitative Studies, at Adheris Health
References1 Swanson A. Big pharmaceutical companies are spending far more on marketing than research. Washington Post. February 11, 2015. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/?utm_term=.fccadf7e5e87
2 Credit Suisse. Rising US rebates limit margin expansion. Global Equity Research. May 2015. Available at: this page
3 Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-290.
4Hubbard TE. Ready for pick-up: reducing primary medication non-adherence: a new prescription for health care improvement. A NEHI Issue Brief. October 2014. http://www.nehi.net/writable/publication_files/file/pmn_issue_brief_10_14_formatted_final.pdf
5 Society for Women’s Health Research. More is sometimes less: women are prescribed a greater number of medications than men but take less of the drugs they need. Press Release: March 19, 2012. http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-MedcoPressArticle&ID=1673845
6 inVentiv Health. Advancing beyond patient-centricity: identifying the real-life influences of health behavior using a social-centric approach. 2017. Available at: http://inventivhealthcommunications.com/social-centricity/
7 Viswanathan M, Golin CE, Jones CD, et al. Closing the quality gap: revisiting the state of the science. Evid Rep Technol Assess (Full Rep). 2012 Sep (2084):1-685.
8 Jing S, Naliboff A, Kaufman MB, Choy M. Descriptive analysis of mail interventions with physicians and patients to improve adherence with antihypertensive and antidiabetic medications in a mixed-model managed care organization of commercial and Medicare members. J Man Care Pharm. 2011;17:355-66.
9 Bogart K, Wong SK, Lewis C, et al. Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients. BMC Psychiatry. 2014;14:15.