Patient adherence and disease education programmes now account for a combined 20 per cent of pharmaceutical brands’ marketing budgets. M Neelam Kachhap speakes to Manish Gupta, Chief Executive Officer, Indegene Lifesystems Bangalore, to know more about the rising trend
Patient adherence is a hot topic for the healthcare industry. Why?
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Manish Gupta
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World Health Organisation defines adherence as the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.
Reports state that the global pharmaceutical market lost about $564 billion, or 59 per cent of the $956 billion in total global pharma revenue in 2011 due to patient non-adherence.
Adherence is important especially in the case of brands serving chronic conditions. Evidence states that it costs fewer dollars to retain a patient as compared to acquire a new patient. The focus is no longer only on acquisition, retention is equally important.
Quality patient support programmes are thus needed to address:
- Differentiation among other brands in a crowded marketplace
- Addressing the expectations of informed patients
- Decrease disease burden and morbidity by ensuring compliance
- Promote a holistic approach which includes lifestyle changes
- Bridge the gap between patient and physicians leading to effective disease management.
Adherence programmes are no longer just a value-add service. They can be used to measure patient outcomes, thus driving the pharma industry shift towards an outcome-based model.
What is the function of patient adherence teams at a pharma company and how many companies in India have these teams?
Most of the large pharma companies today have resources that are either dedicated to the patient support programmes or work with in liaison with the brand teams to develop these programmes. A recent survey reported that a majority of the pharma and biotechnology companies – close 71 per cent of surveyed companies – had dedicated patient adherence teams.
At present most of these programmes are carried out through partnerships with third-party service providers and NGOs. Most of these programmes are aimed at providing patient counselling about disease and wellness, medication reminders, value added services and provide complementary medications to low income group patients.
The function of the patient adherence teams is to design the scope and scale of the adherence programmes. They also work closely with the partner organisations to ensure efficiency of the programs.
What are the patient adherence budget allocations at pharma companies?
The business segment has been growing at a tremendous pace. According to a recent report, overall patient adherence team spending has more than doubled from 2009 to 2011 and nearly doubled again in 2012. In the US specifically, patient adherence budgets rose 281 per cent from 2009 to 2012.
The report also states that the patient adherence and disease education programmes now account for a combined 20 per cent of pharmaceutical brands’ marketing budgets, more than any other single marketing activity.
The budget also differs across geographical territories. The US patient adherence budgets are usually much higher— higher than the average Europe/Canada or Asia Pacific budgets. Being a niche and growing segment, exact numbers for the Indian market are not known. But the trends followed worldwide seem to be followed here as well.
Many pharma companies have turned to outside vendors for these services? Kindly comment.
A recent survey reported that pharma companies spend an average 41 per cent of their overall disease management and patient adherence budgets on outsourcing activities. These percentages vary across the world. 50 per cent of the surveyed companies in Europe and Canada outsource patient adherence efforts, while 38 per cent of the US companies and 33 per cent of Asia Pacific organisations use outside vendors.
Driving the decision for outsourcing are the laws over patient data confidentiality and storage, which have become more and more stringent across the world. Pharmacological companies look for capable partners who can store the data in a secure and compliant manner. Moreover, this also eliminates the possibility of misuse of patient data making both doctors and patients feel more comfortable.
Also, outsourcing specific programme activities allows these companies to more effectively manage several key steps in programme development and focus on core activities.
What kind of adherence-support activities do vendors provide?
Most of these vendors provide a patient-centric model which promotes medication adherence, predominantly for chronic diseases.
While the programmes are designed in conjunction with the parent pharma company, the project, logistic and people management is carried out by the vendor. Once the patients are actively enrolled on the programme, there are various services offered to the patient during the course of his/her therapy.
These services revolve around medication adherence, disease awareness, behavioural counselling, lifestyle modification, drug procurement, medication reminders and other value-added services such as subsidised test coupons, disease literature and so on. The patient is given assistance and support on a regular basis on his doorstep by field counsellors and remotely through telephone calls, SMS, emails and mobile applications.
How many vendors are there in India and what is the market size of this sector?
The Indian market is in a growing stage. Some of the bigger pharma companies have rolled out large patient adherence programmes which are aimed primarily at providing support for patients suffering from chronic conditions such as diabetes mellitus, cardiovascular diseases, and oncological illnesses. While some of these are run as pilot projects, some of these programmes are rolled out pan India employing more than 100 counsellors and engaging thousands of patients.
What are the pros and cons of in-house vs outsourced adherence-support activities?
Outsourcing these activities gives pharma companies a lot of advantages. Outsourcing can eliminate costs of maintaining the infrastructure needed to support the programme specific activities. Moreover, these activities are not their core competency and it need not employ its resources to managing these programmes.
The other bigger advantage that encourages companies to outsource specific portions of a programme is patient data confidentiality. Not only doctors and patients are more comfortable with third-party vendors handling patient records, but also in most countries it is illegal for the pharma companies to store patient data.
Moreover, the companies often develop long-term relationships with these vendors and can leverage the vendors’ expertise to create effective programmes.
What is the future of outsourced adherence-support activities?
With tightening data security laws and the increasing focus on achieving cost effectiveness and operational efficiency, the future of the outsourced adherence-support activities appears to be extremely bright.
As more and more companies realise the need to differentiate their products in an extremely-competitive and almost-commoditised market, value added services in the form of patient support programmes will soon influence the decision to purchase a drug.
Moreover, as the business segment becomes mature, the pharma companies are looking beyond these programmes as mere value added services or corporate responsibility. The programmes are now increasingly being structured so as to measure patient outcomes. This drives the companies to an outcome-based model where increasing adherence can be linked to improved patient outcomes and revenue.
References:
1. http://www.capgemini.com/resources/patient-adherence-the-next-frontier-in-patient-care
2. http://www.indiaoppi.com/OPPI%20Member%20Companies%20Contributions%20in%20Improving%20Access%20to%20Healthcare%20in%20India.pdf
3. http://www.in.capgemini.com/estimated-annual-pharmaceutical-revenue-loss-due-to-medication-non-adherence
4. http://www.micromass.com/downloads/documents/MMC11_PatientSupport_SinglePg.pdf
5. http://www.businesswire.com/news/home/20130312005045/en/Pharmaceutical-Industry-Sees-Sharp-Rise-Patient-Adherence
6. http://www.prnewswire.com/news-releases/disease-management-and-patient-adherence-41-of-program-budgets-are-outsourced-53292062.html
7. http://www.reuters.com/article/2013/04/18/nc-cutting-edge-info-idUSnBw185011a+100+BSW20130418
8. http://www.cuttingedgeinfo.com/2011/patient-adherence-disease-education-pharmaceutical-marketing-budgets/