AXS26: Exploring Medication Nonadherence in Specialty Therapy Beyond What Reminders Can Fix

In an interview with Pharmacy Times at Asembia’s AXS26 Summit, Michael Oleksiw, CEO of Pleio, a digital patient support company headquartered in New York, discussed data presented at the conference highlighting the persistent challenge of medication nonadherence in specialty therapies, noting that approximately half of all treatment failures are attributable to adherence issues. He explained that purely mechanical solutions, such as reminders and nudges, often fail to address the emotional and psychological barriers patients face and that a combination of artificial intelligence (AI)–driven insights and human-centered outreach is needed to build confidence, improve understanding, and support long-term engagement. Oleksiw pointed to the glucagon-like peptide-1 (GLP-1) medication space as a particularly complex example, where stigma, dose escalation, and recurring emotional hurdles can make adherence especially difficult.

Pharmacy Times: Can you introduce yourself and explain your current role?

Michael Oleksiw: I'm Michael Oleksiw. I'm the CEO of Pleio, focused on making the best of patient health care journeys by helping them develop long-term relationships with their therapies.

Pharmacy Times: Can you give us an overview of the nonadherence problem in specialty therapy today—how significant is it, and why has it been so difficult to solve?

Oleksiw: Nonadherence in specialty medications is particularly interesting, largely due to the complex nature of the therapies and the complex nature of the patients who are on those therapies. The problem is really large because these are obviously chronic disease states in rather deep conditions. On a good day, 50% of patients are noncompliant. When we look at cases where patients don't respond to therapy or have noncompliance, 30% to 50% of failures on specialty medications are due to adherence issues. In the case of something like rheumatoid arthritis, nonadherence rates are between 44% and 85%—a wide range—but generally speaking, about half of patients fail on their therapies due to nonadherence.

Pharmacy Times: Most adherence solutions focus on logistics—reminders, refills, follow-ups. Why are those falling short, and what's the emotional barrier that's really driving patients to stop therapy?

Oleksiw: On the premise that we are talking about a relatively complex problem, sometimes the solutions need to be simple, but not too simple. When we look at things like reminders, nudges, etc, behaviorally, they tend to remind patients that they're forgetful. Behaviorally, they can act as a crutch. These mechanical solutions typically don't get to the core of the problem—they don't address the complexity, which includes functional barriers such as forgetfulness and financial concerns, clinical components, and emotional components like knowledge, confidence, and skills that all come into play together. It's not enough to just poke, prod, and nudge a patient to remind them they're forgetful and remind them that they're sick. We need to uplift, educate, and instill confidence in patients, and that's where targeting the emotional barriers comes into play.

Pharmacy Times: How does pairing AI-driven insights with human-first outreach address fear, doubt, and discouragement in a way that purely digital tools can't?

Oleksiw: The great thing about dialogue and human connection is that we get to engage with people in a judgment-free zone. There's conversation, there's dialogue, and AI is particularly good at looking at vast amounts of data and understanding [them] in ways that humans can't. It's sort of the ultimate complement to the human, as opposed to replacing the human. With AI, we can do basic things—we can look at sentiment, tone, and peaks and valleys in a discussion—but more importantly, across millions of conversations, we can look at the overall vibe of the conversation and cause-and-effect relationships. We can look at the impact that our words and actions have on a person in a specific interaction and then tie that to performance data to see how the patient performed as a result of the conversation. AI really gives us the wisdom of crowds when it comes to conversations with patients.

Pharmacy Times: You've seen the emotional barriers to adherence play out specifically with GLP-1s—what makes that patient population particularly vulnerable, and what's working?

Oleksiw: The GLP-1 space is very interesting—obviously a very hot topic right now. If we split the GLP-1 indications, you have diabetes indications, but let's focus on obesity as an example, because it's a very good example in the emotional space. When we first started talking about GLP-1s in the obesity space, they were called the "fat jab" and referred to as vanity drugs. We've since collectively come to understand and appreciate that this is a medical condition—a disease state—and it merits that level of focus. The stigma that comes with obesity drugs based on GLP-1s is a very good example of an emotional barrier. Then there's the complexity of the treatment itself: Dose escalation and titration mean there's a starter dose and multiple therapeutic doses to work up to. You can think of each dose increase as a new start, so the patient is essentially going through that emotional weight on multiple occasions while on the same drug. That makes it especially unique. There's always a cascading array of emotions around pretty much any drug, but GLP-1s in the obesity space are a particularly vivid example.

Pharmacy Times: What does improved adherence actually mean for the total cost of care, and why are payers and pharma manufacturers starting to pay closer attention?

Oleksiw: We started by noting that roughly half of treatments fail due to nonadherence. The question is, what’s the impact? There's a large opportunity to solve the problem, and every 1% increase in adherence translates to a $2 [billion] to $7 billion reduction in health care costs across the board. The impact is very large because there's a cascading effect—it's not just about one individual who stops their treatment and is no longer paying for a medication. There are obviously hospital readmissions and broader societal consequences as well.