1. Patient support programmes within
medicines optimisation – the pros and cons
Andy Carter | Director of Strategy
Atlantis Healthcare

2. Patient Support
Programmes within
medicines optimisation
“Good commercial value or
bad investment”
Andy Carter
Director of Strategy, Atlantis Healthcare

3. Adherence to long-term therapy for
chronic illnesses in developed countries
averages 50%. In developing countries, the
rates are even lower1
1. WHO: adherence to long-term therapies: Evidence for action. 2003

4. 1. IMS Institute for Healthcare Informatics – Advancing the responsible use of medicines:
Applying levers for change, Oct 2012
The health spending that can be
avoided in this way amounts to 8%
of total annual health expenditures
worldwide1
"Responsible" meds use can save $500B/year globally
More than half ($269B) can be
gained through improved patient
adherence, according to the
report1

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Medication optimisation is on the UK’s agenda
Royal Pharmaceutical Society
Medicines Optimisation:
Helping patients to make the most
of medicines May 2013
CG76 Medicines adherence:
NICE guideline Jan 2009
£300m medicines wastage v’s £500m/year estimated opportunity cost of
health gains foregone due to meds optimisation1
1.York Health Economics Consortium & the school of pharmacy, university of London, Evaluation of
the scale, causes and costs waste medicines 2010

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Pharma investment reacting to medicines optimisation agenda

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Non adherence transcends all conditions

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Cochrane - acknowledges the importance of medication adherence
“Effective ways to help
people follow medical
treatments could have
far larger effects on
health than any
treatment itself”
1.Cochrane review: “Interventions for enhancing medication adherence” 2008

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Poor adherence is costing pharma hugely in lost revenue
Even a modest 10% increase in adherence could lead to a significant rise
in revenues, accompanied by improved health outcomes and decreased
healthcare spending.
Global pharmaceutical market revenue loss is
estimated to be $564 billion, or 59% of total
global pharmaceutical revenue in 2011
Firlik K et al, Estimated Annual Pharmaceutical Revenue Loss Due to Medication Non-Adherence, Nov 12

10. The evidence to date
Patient adherence
interventions / support

11. Inconclusive findings - but acknowledged scarcity of evidence
Haynes et al, Interventions for enhancing medication adherence. Cochrane database of systemic reviews 2008, Issue 2
Authors’ conclusions:
“For short term treatments, several quite simple interventions increased adherence
& improved patient outcomes, but the effects were inconsistent from study to study.”
“For chronic conditions, interventions are mostly complex and not very effective.”
Short term treatments
- 5/10 interventions improved adherence
- 4/10 interventions improved clinical outcomes
Long-term treatments
- 36/83 (43%) interventions improved adherence
- 26/83 (31%) interventions improved clinical outcomes

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A consistent weakness in research to date around adherence
NHS – SDO CRITICAL REVIEW
Horne, Weinman et al, 2006
• A narrow focus & failure to consider both intentional and
unintentional non adherence
• “One-size-fits-all approach” (i.e. not personalised)

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Perceptions & health beliefs drive intentional non-adherence

14. The impact of
personalised
interventions
Product All preventer inhalers
Programme name Asthma AIM
Publication Published British Journal of
Health Psychology

15. Overview
• A scalable intervention programme
designed to increase adherence to
asthma preventative medication
• Programme developed in conjunction
with the University of Auckland and
supported by Vodafone
• Programme conducted as part of a
randomised controlled trial (RCT)
• Programme comprises 18 week text
message package tailored to the
individual’s illness perceptions &
medication beliefs
A study targeting patient beliefs to improve adherence

16. Improved adherence in asthma intervention group
Adherence% Average adherence over all time points was 43.2% in
control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves
Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.

17. Personalised programmes can deliver lasting behaviour change
0
10
20
30
40
50
60
70
Baseline 6 Weeks 12 Weeks 18 Weeks 6 Months 9 months
Control Intervention Group
AverageAdherence%
Intervention ceases at 18
weeks, adherent behaviour
continues
Average adherence over all time points was 43.2% in
control group v’s 57.8% in intervention group
Keith J. Petrie, 2012, A Text Message Programme Designed to Modify Patients’ Illness and Treatment Beliefs improves
Self-Reported, Adherence to Asthma Preventer Medication, British Journal of Health Psychology 17, 74-84.

18. Patient support
programmes with
personalised interventions
- Delivering positive ROI

19. HCP’s differentiate brands with patient support programme
Specialist physicians
surveyed - 61% stated the
availability of the patient
support programme would
likely impact on their
choice of treatment
Independent market research 2013 – data on file

20. Patient support programme
Patients with wet age related macular degeneration (AMD)
12 month patient support. Interventions
included:
- seminars
- nurse calls
- welcome packs for carers & patients
- Self monitoring tools
- DVD’s & Audio
Strategy
1. Empower patients to take control
2. Create a patient support programme that is valued by patients and is recognised
by HCP’s
3. Differentiate product from its competitors
Atlantis Healthcare - Data on file
Programme running for 5 years due to positive commercial return

21. Commercial return prolific
• 8 fold decrease in drop out – 3% of patients on the program
discontinued treatment versus 24% not on the program
• Patients on the program have on average 2.5 additional scripts
per annum
• 3,000 patients enrolled
• ROI = 941%
Average number of treatments per time period
n 3 mths 6 mths 9 mths 12 mths 15 mths
Non PSP 2645 2.78 4.30 5.38 6.22 7.00
PSP 316 3.20 5.52 7.21 8.70 10.38
Atlantis Healthcare - Data on file

22. The ability to develop value propositions
Roebuck C, Liberman J, Gemmill-Toyama M et al. Medication adherence leads to lower health care use
and costs despite increased drug spending. Health Affairs, 30, no.1 (2011):91-99
Therapy area Return on investment
Chronic heart failure 8.4 : 1
Hypertension 10.1 : 1
Diabetes 6.7 : 1
Dyslipidaemia 3.1 : 1

23. Key learnings &
recommendations

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Steps for developing the case for an adherence strategy
BUSINESS CASE
Including summary of key opportunity, alignment needs, implementation needs, recommended
skeleton solution overview (outcomes, measurement, budget, timings, CSFs)
Adherence issues and
opportunities
identified?
The organisation is
aligned to address
these issues?
Solution framework
and implementation
considerations
developed?
Investment
defined, and
potential impact
assessed?
1 2 3 4

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Investment needs to be better distributed between acquisition & retention
Oliver Wyman Report: A Prescription for Change: The New Go-to-Market Model for the Pharmaceutical
Industry 2009.
Effective Adherence
Solutions
Marketing budget spend
89% v’s 10% v’s 1%
On patient Payor On patient
acquisition marketing retention

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Adherence strategies can deliver for ALL stakeholders
Patients
Do more, feel better, live
longer
Personalised solutions
Pharma
Improved sales from
existing patients
Improved market
access
Competitor
differentiation
Healthcare
Improved outcomes
Reduced wastage
Lower healthcare
utilisation