The take-your-medicine program is part of a sales and marketing strategy that is

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Sat, 11 Mar 2006 08:43:42 -0500

[sSRI-Research] The take-your-medicine program is part of a

sales and marketing strategy that is gaining urgency for drug makers

experiencing slowing sales.

 

 

 

[-- wanna puke?]

 

 

March 11, 2006

 

Take Your Pills, All Your Pills

 

By ANDREW POLLACK

 

Joseph A. Brocato's weekly self-injections of a drug to treat

hepatitis C left him so feverish and fatigued, he said, he often

thought of quitting. He didn't, thanks to a nurse who urged him by

phone to stay the course.

 

The nurse, Colleen Dinsdale, did not work for Mr. Brocato's doctor.

Rather, Ms. Dinsdale was paid by the drug's maker, Roche, and its

distributor, McKesson. Each month that Mr. Brocato took the drug,

Pegasys, and its companion pill, ribavirin, meant $3,000 in sales -

most of it paid by his insurance company. His share was a $50 co-payment.

 

The take-your-medicine program is part of a sales and marketing

strategy that is gaining urgency for drug makers experiencing slowing

sales. As it turns out, the industry leaves billions of dollars on the

table - or the pharmacy shelves - annually because people do not take

their drugs as often or as long as prescribed.

 

And so the hand-holding with patients like Mr. Brocato, who recently

completed his yearlong course of therapy. " They don't ever let a week

go by that they don't contact you, not just to say you are coming up

on a refill of your drug but just to say, 'How are you feeling?' "

said Mr. Brocato, a 57-year-old auto parts deliverer who lives in

Dundalk, Md. He said he called Ms. Dinsdale so much that he programmed

her number into his cellphone.

 

Stimulating sales this way is the focus of other industry initiatives,

including television advertisements like one by AstraZeneca in which a

doctor asks a series of patients if they are taking their Toprol-XL

hypertension pills daily. " You can't forget, " the doctor gently

scolds. " High blood pressure can make your heart work harder than it

should, every day. "

 

Lending credence to such efforts are many studies showing that failure

to take medicines as prescribed can cause patients to develop more

serious and costly complications later. So as industry tactics like

wining and dining doctors draw scrutiny, spurring people to take their

pills is a less controversial way to increase sales, one that the

industry says is in the best interests of patients and insurers.

 

Still, the efforts are not without detractors. Some medical experts

worry about consumers' privacy or the possibility of undermining

doctor-patient relations. There are also questions about the

industry's motives.

 

" They're about brand loyalty and not about public health, " said Dr.

Jerry Avorn, a professor at Harvard Medical School and the author of

" Powerful Medicines, " a book critical of pharmaceutical marketing and

regulation.

 

Dr. Avorn nevertheless said that low patient compliance with

prescriptions was a big problem for the industry and public health.

" I'm often surprised to hear drug companies worry about increasing

their market share from 7 percent to 9 percent for a particular

disease, when the 500-pound gorilla issue is that half the people who

were prescribed those drugs aren't taking anything, " he said. " A ton

of money is wasted on paying for drugs which people use so irregularly

that they get no clinical benefit. "

 

The World Health Organization, in a report in 2003, called

noncompliance a " worldwide problem of striking magnitude. " It

estimated that in developed nations, half of patients did not take

medicines for chronic diseases in the prescribed manner.

 

Insurance companies have their own programs to get customers to take

their medicine. But it is the drug companies that feel the most direct

impact when patients fail to finish or renew prescriptions.

 

" We talk about this in terms of the leaky bucket, " Anne M. Faul,

director of pharmacy strategy and analysis at GlaxoSmithKline, said on

a recent Webcast organized by Frost & Sullivan, a consulting firm, and

sponsored by McKesson.

 

GlaxoSmithKline, which makes the diabetes drug Avandia, is offering to

pay for employer groups in 10 cities to replicate an experiment that

started in 1997 in Asheville, N.C.

 

In that test, Asheville municipal employees with diabetes were

encouraged to take treatments for their disease, through efforts by

pharmacists and diabetes educators and by the waiver of co-payments.

As a result, the patients' control of their blood sugar improved and

the city's overall medical costs fell. Spending on drugs alone,

however, increased.

 

Research finds various reasons that people do not take their

medicines. Forgetfulness accounts for about one in four cases,

according to a survey of 10,000 people in 2002 by Harris Interactive

and the Boston Consulting Group. Another reason is that patients may

feel no urgency about taking daily pills for conditions like

osteoporosis and high cholesterol, in which drugs do not relieve any

immediate symptoms but reduce the risk of future problems.

 

Other reasons, cited by the survey and other specialists, are ones the

drug industry's inducements cannot necessarily resolve - like

complaints that the drugs cost too much or do not work or cause

unpleasant side effects.

 

Kay Wissmann of Chicago said she stopped taking tamoxifen, intended to

prevent a recurrence of breast cancer, because it made her feel

terrible and exhausted. " That's one of the things oncologists don't

realize, because they've never taken the medications themselves, " she

said.

 

Even though she had a relapse of cancer, she said that not taking the

drug was the right decision.

 

AstraZeneca, which sells tamoxifen under the brand name Nolvadex and

another breast cancer drug, Arimidex, helped pay for a meeting of a

group of cancer patient organizations in Washington in November to

plan a compliance initiative. A paper is now being prepared and

discussions are continuing on possible remedies, said Terri Ades,

director of cancer information at the American Cancer Society.

 

Some companies let patients enroll in a program that provides

information about their disease as well as reminders to take their

drugs. Novartis, for example, recently started BP Success Zone for

users of its blood pressure drugs, including Diovan, its biggest product.

 

Customers can interact on a Web site, through e-mail or regular mail

or at the pharmacy. Patients are offered advice on diet and exercise.

They can also get a free monitor to test their blood pressure.

 

" You've got to give them some success metric, " said Kurt Graves,

global head of the general medicines unit of Novartis.

 

Participants receive a card that entitles them to discounts on

refills. When the card is used, it provides information to the company

on how often patients renew prescriptions.

 

In Florida, Eli Lilly is offering the state's Medicaid program a

bigger discount on Zyprexa, the schizophrenia drug, the longer

patients stay on it. It is up to the state to figure out how to keep

patients on the drug.

 

It is the brand-specific nature of some programs that concerns some

specialists. Dr. David S. Sobel, medical director for patient

education and health promotion in Northern California for Kaiser

Permanente, a big health maintenance organization, said drug company

compliance programs were not necessarily bad but that Kaiser preferred

to run its own.

 

" If somebody's in a program for a certain statin and we change that

statin, are they out of the program? " Dr. Sobel said, referring to

cholesterol-lowering medication. " If it goes generic, do they shut

down the program? "

 

Dr. John Abramson, a physician and author of " Overdosed America, " said

another potential problem was that medicines were overprescribed. In

such cases, compliance programs would be inducing people to keep

taking pills they did not need.

 

Some specialists say there is a potential for abuse in the closer

links being forged between pharmaceutical companies and their

patients. In the past, drug companies generally dealt only with

doctors and insurers.

 

But organizers of the industry programs say that instead of bypassing

the doctor, they are providing services like 24-hour-a-day call

centers that many doctors cannot. " We are an extension of the

physician's office, " said Kerr Holbrook, vice president for marketing

at McKesson's specialty pharmaceuticals division, which runs the

program that worked with Joseph Brocato.

 

Patients generally join such programs voluntarily, so privacy is not

an issue, they say. In some cases the doctors recommend the programs

to patients, saying the company efforts are useful and

unobjectionable. " They have really been hands off with corporate

influence, " said Dr. Robert G. Gish, a hepatitis specialist in San

Francisco who is a consultant to various drug companies.

 

The National Multiple Sclerosis Society, a patient advocacy group,

said it stopped its own compliance programs because the drug companies

were doing such a thorough job.

 

Still, the programs tend to be for more expensive drugs. " Candidly,

the higher the price of the drug the more likely that somebody is

going to do this, " said Ted Dacko, president of HealthMedia, a company

in Ann Arbor, Mich., that runs compliance programs for drug companies

and insurers. " You're not going to be doing this for Tums. "