With medication adherence, more is more

A new study by health care analytics company, SDI reveals a promising insight on how to drive medication adherence.

[P]rescribers who consistently wrote prescriptions with four or more authorized refills per prescription had patient populations that filled more scripts, on average, than those who authorized fewer refills or whose patients required a new prescription in order to obtain their medication. This suggests that prescribers may be able to influence patient adherence with something as simple as authorizing more refills when they write prescriptions.

Weak pipelines, patent expirations, tight formulary control and curtailed pricing power have taken away the traditional big pharma growth levers. Improving medication adherence offer the last, best hope for big pharma revenue growth because it means more sales to existing users and a greater chance that the drugs will improve outcomes. That's why this information is likely to be of major interest to pharma companies.On the other hand the study reminds me of some inconvenient truths about medication adherence and the business models of analytics companies such as SDI. In particular:

• The only medication adherence programs that seem to generate a positive return on investment are low tech, low cost. Despite the investment by big pharma companies in a variety of patient support programs, devices, psychographic profiling and so on, the only adherence approach with a consistenly positive return on investment has been sending refill reminder letters from pharmacies (typically sponsored by the pharma companies). The other, fancier approaches are pretty cool and have some impact, but their incremental costs usually outweigh their incremental advantages. Granting additional refills on the initial prescription is an example of a cheap, workable program. Pharma reps just need to convey the point to physicians. It shouldn't be too hard. (Although some docs probably write fewer refills to encourage patients to come back more frequently.)
• SDI used "anonymized patient level data" (APLD), which relies on matching individual patients to prescribers and tracking them over time. SDI uses matching algorithms to try to figure out which patient is which. Several companies including IMS, NDC (acquired by Wolters Kluwer) and Verispan (which SDI recently acquired) each sank tens of millions of dollars into building APLD businesses. Although APLD is a neat idea that represents a real improvement over the traditional IMS metrics, it's been hard for the data companies to recoup their investments. Insights like the one described in this study are interesting, but once the information is out there there's no real need to pay SDI to do the analysis again and again. So companies like this end up doing one-off studies for tens or hundreds of thousands of dollars. Meanwhile everyone can apply the "more refills is better" insight without paying SDI or anyone else.
• The serious money in pharmaceutical prescribing analysis is still made by IMS, because its data is used for sales force compensation. That information has value on an ongoing basis. There's also great resistance to changing an established system that's working because it impacts sales reps' compensation.