Moses Zonana

	Nearly half of patients taking medications for chronic disease discontinue the drugs or do not take them as prescribed, according to the FDA. While these treatments can help patients who take them properly, many have narrow pharmacokinetic and adverse effect profiles. As a result, poor adherence increases the risk of complications and worsens outcomes for patients. 

	Nonadherence and therapy discontinuation contribute to more than 125,000 deaths and cost the United States between $100 billion and $300 billion annually, according to the CDC. The specialty pharmaceutical industry, expected to account for 50% of all medication spending in the United States by 2020, according to a report by McKesson Corporation, is increasingly feeling the pain of the adherence epidemic. 

High Discontinuation of Specialty Pharmaceuticals Remains a Struggle 

	Given the high cost of specialty drug treatments, maximizing their efficacy is paramount. Scrutiny of drug pricing is near the top of the national discourse and is a priority for specialty manufacturers and pharmacies alike to help ensure that these treatments yield their publicized results. 

	Yet for many specialty pharmaceuticals, the discontinuation curve, a measure of how many patients prematurely stop taking their prescribed medication, can jeopardize outcomes. The fact is, for certain specialty therapies, up to 30% of patients discontinue medication within the first 90 days of treatment.  

	Specialty pharmacies can play an important role in minimizing discontinuation and helping patients adhere to their medication, but their approach to patient support and follow-up is often archaic. Historically, pharmacies have employed nurse call centers to place cold follow-up calls with customers. 

	These nurse support teams are typically expected to manage compliance without any knowledge of the patient’s activity after a prescription has been filled. That means specialty pharmacies are providing patient support while effectively blindfolded. 

	Frequently, patients who are taking their medications as prescribed are telephoned unnecessarily. At the same time, patients who are not adhering to their regimen are often not called after the first or second missed dose. This results in suboptimal allocation of resources and missed opportunities to intervene at critical moments—before patients enter the discontinuation curve. 

	Until now, specialty pharmacies have had limited or delayed visibility into their customers’ dosing habits and into the behaviors that result in poor medication adherence, such as procrastination, forgetfulness, and fear of adverse effects.  

Intelligence Can Transform Specialty Pharmaceutical Support

	Today, new paradigms and technologies can better support specialty pharmacy adherence programs. When armed with intelligent touch points, specialty pharmacies can connect with patients before they drift from proper habits. They can also prevent intrusion into the lives of patients who are taking their medications as prescribed. 

	Technology-driven customer intelligence and analytics helped Netflix transform the customer experience of media consumption by recording and analyzing viewing habits and applying them to make highly targeted recommendations. By pairing a smart technology strategy with support interventions, specialty pharmacies can also transform their customer support experience. When they apply real-time intelligence about medication utilization, specialty pharmacies can engage the right patients with the right message at the right time. This leads to more return on the investment in customer support and lower discontinuation. Right-time engagement improves outcomes for patients, efficiencies for pharmacies, and the bottom-line for everyone.   

Smart Medication Adherence Technology Can Deliver Actionable Intelligence

	How do specialty pharmacies gain customer intelligence? They can use smart medication adherence technology: internet-connected tools that offer comprehensive levels of medication monitoring and control, both for patients and for those who support them.

	A broad array of technologies now exists to remind patients when to take their medication and record their behavior. There is a large variation in feature sets and capabilities of this technology. If you are considering adding technology to enhance your patient support experience—and you should&mdash;it’s important to choose a comprehensive solution that includes customizable clinical, behavioral, and analytical tools.

5 Components Your Medication Adherence Technology Must Have

	Here are essential areas to look for in a smart medication adherence technology solution:

	To be effective, adherence technology should work right out of the box and not have many asks from the patient. Patients should not be required to set up a device or download an application. Implementation should also be easy and unobtrusive for the pharmacy. For example, the technology should integrate automatically with standard pharmaceutical packaging so that it does not conflict with dispensing workflows. Analytics software should be simple to connect to existing databases and intuitive to use. Solutions that offer both desktop and mobile access across all technology platforms and operating systems are the most flexible. Two-way communication between support team members and the patient is essential. 

2. Comprehensive, actionable patient insight.

	The most effective solutions not only track and gather data on medication access and usage but also organize the metrics in a way that maximizes visibility and facilitates action for support team members. The analytical tool should be flexible enough to aggregate and display behavioral data by multiple views and categories, including individual patient, geography, and therapy class. Detailed dosing logs should be viewable in graph or list form. Communications and notes (by support team members) should be automatically added to the analytics. For reporting flexibility, a tool that integrates automatically with Excel, Word, and PDFs is ideal. Aggregate reporting of real-life dispensation and adherence patterns can be shared with drug manufacturers and may facilitate outcomes-based contracting.

	An adherence technology solution must be highly configurable to meet the unique needs of your organization and your patient population. For example, you should be able to set and adjust different patient reminder alert preferences, including visual and audio reminders. Support teams should also be able to customize how they receive alerts on their end, whether it be by e-mail, text, or phone. A configurable, rules-based triage notification/escalation system facilitates timely follow-up and intervention. The analytics software should also be customizable, with flexible and adaptable information displays. 

	Smart adherence technology should not only record all data about medication dispensation but also deliver the information in real time to notify support team members of opportunities to intervene. For example, if the pharmacy identifies 2 missed doses as an intervention threshold, the support team should receive an alert in real time as soon as a patient misses the second dose so that the team can take the right action in a timely manner.

	Be sure that your technology solution is robust and protected with a 21 CFR Part 11—validated system that is compliant with the Health Insurance Portability and Accountability Act of 1996.

	Here’s an example of a scenario in which a specialty pharmacy can apply smart medication adherence technology to engage with patients before they discontinue therapy:

	1. The specialty pharmacy or patient support program enrolls the patient in a medication adherence technology—enhanced program.

	2. The specialty pharmacy dispenses to the patient the first prescription fill, which includes data capture and alert technology built into the medication packaging.

	3. The patient is alerted with a reminder to take a dose as prescribed through a visual or audio cue and reminded to eat a meal before dosing, if advised.

	4. The patient takes a dose on time. The dosage data are recorded and transmitted securely to the support team’s database and analytic tool and captured for reporting.

	5. The patient misses a dose or reports undesirable symptoms after taking a dose. This information is sent in real time as a notification to the support team members via the communication method they selected as their preferred medium.

	6. A support team member sends a personalized message to the patient via the portal, or calls them, to discuss and resolve the challenge before it magnifies. 

	Health care organizations that have incorporated smart technology into their patient support programs have seen their average medication adherence improve from 75% or less to 95% or more. If you’re ready to improve your persistency curves, optimize your patient support, and improve your patient outcomes, it’s time to add intelligence and analytics to the medication adherence equation.

Moses Zonana attended Rutgers University and obtained his B.A. in Mathematics. In 2005, he earned his MBA from Harvard Business School with academic honors. With more than 15 years of executive-level experience, Zonana used his diverse expertise in healthcare, telecommunications and technology to develop Compliance Meds Technologies (CMT), a health technology solutions provider that offers patient-centric, enterprise-grade solutions that empower personalized and coordinated medication adherence interventions and patient engagement.

Articles

Technology-driven customer intelligence and analytics allowÂ specialty pharmacies to connect with patients before they drift from proper habits.