Ideally, healthcare organizations should simultaneously pursue three interlocking goals: Improving population health outcomes, reducing per capita healthcare costs, and enhancing patient experience. All too often, however, pharmaceutical clients focus on the first two of these goals while almost completely neglecting patient experience. While pharmaceutical companies have long been respected for their research and development capabilities—optimizing for outcomes and demonstrating ROI in avoided medical costs—they have rarely been lauded for their user experience. By neglecting this territory, pharmaceutical companies not only leave untapped opportunities, but they also diminish the ROI on their decades of R&D. Pharmaceutical companies must realize that investments in patient experience can be a real value-add for them, the healthcare system and, most importantly, for patients.
The process of commercializing a new drug is similar to a relay race. In the first leg, pharma companies must prove that the drug works. In the second leg, they must ensure insurance plans will cover the drug by demonstrating that it will reduce overall per capita costs. In the final leg, they must ensure that the patient’s experience with the drug leads to high medication adherence. After years of R&D, after demonstrating the functionality and affordability of a new product, many pharma companies consistently drop the baton in the home stretch and fail to achieve drug effectiveness. Imagine spending a decade of your life training for a relay race, and on the final leg, your team drops the baton. Drug companies repeat this mistake over and over again, failing to recognize the importance of patient experience in achieving effectiveness. Why?
Efficacy vs. Effectiveness
Drug efficacy–the ability of a drug to do what it claims to do–is proven in homogenous, highly controlled clinical trials. However, drug effectiveness–a measure of the actual outcomes obtained by actual patients prescribed the medication–depends completely on whether patients take the drug exactly as prescribed in real world scenarios. That means a drug may have a high level of efficacy, but still have low effectiveness. Unfortunately, drugmakers are not mandated to perform an effectiveness trial after an efficacy trial, creating a glaring flaw in how U.S. pharmaceutical companies design for patient experience.
Without reliable effectiveness trials, the entire healthcare system incurs unnecessary costs. When a new drug enters the market, between 25% and 50% of patients prescribed the drug will not take it as prescribed. This lack of medication adherence has not only been associated with 125,000 deaths and 10% of hospitalizations annually, but is also responsible for pharmaceutical companies losing $637 billion in revenue per year. Health plans understand this relationship between medication effectiveness and long-term cost, and consequently place greater importance on a drug’s effectiveness than its price. According to a Stanford study, 93% of all plans and 98% of large plans will cover a more effective intervention, even if it is more costly.
We clearly understand the costs of medication non-adherence, so why do up to half of patients still fail to take their medications as prescribed? Non-clinical factors and patient experience are the main causes of this phenomenon. When prescribed a medication, taking it becomes yet another of the many daily responsibilities that patients must manage. On top of their careers, caregiving, personal and social responsibilities, patients must remember to fill their prescription and take their medication exactly as prescribed.
Today’s patient experience in regard to medication adherence has many external factors. The below chart outlines some of the key areas or pitfalls where we see adherence dropoff:
Adherence drop-off can occur for a number of reasons:
Create patient personas representing your largest patient segments. When sketching the personas, first consider demographic clusters including gender, sexual orientation, economic status, age and other relevant characteristics. Once you identify the target demographic, begin sketching out its non-clinical characteristics including interests, needs and desires. Ethnographic interviews are an excellent research tool to assess non-clinical attributes of a patient population (learn more about frog’s favorite research resources here).
This exercise will give you a much clearer picture of the competing life priorities that may impact medication effectiveness, and the process itself builds empathy with the target population, helping researchers better understand how different drug delivery mechanisms may fit into patients’ lives.
Once patient personas have been defined, create a patient journey map to clearly outline the competing priorities at all stages of the medication experience. The patient journey map should be exhaustive, beginning when they first realize they need medical attention and ending when they need to refill their prescription. Through this process pharma companies can create a list of both the riskiest non-adherence areas and the contexts that lead to those risks. Understanding the context is critical to creating innovative mechanisms to promote adherence.
Also consider launching a quantitative survey as a supplement for qualitative research in order to quantify or measure the reasons for non-adherence. When assessing the results of such a survey, be careful not to prioritize solving the most commonly cited reason for non-compliance simply because it is the most common–you must also consider which opportunities may be the easiest or most difficult to solve for. Motivating human behavior is no simple feat, and will require significant investment in design to meaningfully move the needle. If there are reasons cited for non-adherence that are beyond your control, de-prioritize them in favor of others where your influence will be greater.
Given the multitude of drop-off points for some medications, the ideal drug delivery system should avoid dependence on patient intervention to promote effectiveness. Therefore, when it is clinically viable, pharmaceuticals should prioritize designing drug delivery mechanisms that do not require repeated patient intervention. A prime example of eliminating patient intervention is the IUD, which has become the fastest growing method of birth control. Between 2002 and 2017 the use of IUDs increased from 2% to 14%, while the use of birth control pills decreased by one-fifth. Because the IUD removed the need for patients to remember to fill and take their prescription during regimented intervals, it is 20 times more effective than the birth control pill.
When the delivery mechanism–a pill, in the case of most pharmaceuticals–cannot be changed, companies can use divergent thinking to redefine the patient experience instead. Divergent thinking challenges business leaders to explore a wide variety of solutions without restraint. The objective of divergent thinking is to define the realm of possibilities and then narrow them down to identify those innovations most likely to affect medication adherence.
There are many examples of innovative medication adherence solutions on the market today. For example, AdhereTech’s tech-enabled pill bottles have improved adherence by 15%. Gamification is another viable path, as demonstrated by Walgreens’s efforts to incentivize medication adherence through gamification adjustment. There are also opportunities in the medication delivery space, as we’ve seen with Amazon’s purchase of PillPack for $753M.
frog’s own healthcare practice regularly works with pharmaceutical clients to improve the effectiveness of their life changing therapies in the ways described above. In our experience, decades of R&D investments often cause these clients to over-index on the clinical efficacy of their therapies. While efficacy is absolutely critical, it is table stakes, particularly in hypercompetitive markets. That’s why we recommend our pharmaceutical clients consider patient experience as the key factor in improving medication adherence. Practically, this means a substantial investment increase throughout the drug development lifecycle in order to identify medication drop-off points and address them through thoughtful experience design, helping patients see the full potential of their therapies.
Some might balk at this new and increased development price tag, but If pharma companies brought the same level of rigor and creativity to medication adherence strategy as they do to the drug discovery process, they would create tremendous value for the entire healthcare system. Greater medication adherence would not only drive greater customer lifetime value for pharma, it would also yield better health outcomes, likely reduce per capita health costs and improve patient experience, finally bringing the baton across the finish line.