There was a big hullabaloo about CVS stopping the reminder calls (sponsored by pharma) because of the stricter interpretation of HIPAA. http://www.pharmalive.com/cvs-ends-refill-reminders-as-new-privacy-rule-looms/?cid=nl_pharma_pharmalot
But what amazed me about the article was that it spoke of only policy and skirted the anemic attempts of the entire industry to tackle this amazingly complex and very human issue of "I don't want/need to take this drug anymore." The article took a typcially one-dimensional view of a four dimensional challenge.
I ran an adherence conference for a Big Pharma a few years ago and of the 23 patient advocacy groups that attended, none really could afford to spend their tight budgets on adherence and what was worse, they all were woefully ill-equipped to do so, on many fronts. Not for ill intent, but they, like so many well-versed pharma/biotech marketers, are just not able to handle the ongoing complexity and the agility needed to craft, launch and optimize such adherence programs.
It seemed like one piece of good news was the rise of pharma companies budgets for patient adherence, moving over the $1 million mark. Yet, no other industry spends more acquiring customers, only to see them mysteriously fall off the 120-day cliff for reasons unknown — even for horribly chronic or life threatening diseases. (To show how small wins can loom large, I know of one email-based adherence program for diabetes where the results were considered hugely successful — because they increased the refill of the drug one extra month…given the fact that a small % of patients signed up for it, this was truly a minor league win.)
In a recent NIH literature review of 160 papers on adherence, they investigated just one of the plethora of variables, cost…did increased cost being put on patients negatively impact outcomes? Those of us who have studied this problem know it ranges from cost to attitude to family history to sometimes inconvenience to the last great barrier of "Taking this drug makes me feel like I am sick, I don't like that."
The bottom line is that the the pharma and biotech companies are probably not going to be the ones that break the code on patient adherence — I believe it is likely to be the hospital and digital doctor who will have the best success because of technology adoption and patients being being forced to engage more aggressively in their healthcare. Between EHR, remote monitoring, smart devices, and a human team surrounding and finally having a single view of the patient, you have the greatest likelihood of applying those technologies with good old behavioral segmentation to define best what patients need what kind of "reminders" — really personal motivation — to adhere to the treatments they need.
Part 2 of this Adherence rant will be about how pharma/biotech companies can re-structure themselves to meet the needs of patients and staying on the medications.