Medicine Optimisation: The Next Blockbuster Treatment for Pharma?
LTC - Long Term Conditions: Medical conditions that are controlled by therapies on an ongoing basis. Quite often these medicines aren’t taken as prescribed, which can result in preventable hospital admissions that add unnecessary pressures onto health clinics. 1
Medicine Optimisation: The focus on the patient’s journey from prescription to consumption with the view to optimise how drugs are ingested and prevent non-adherence.
Experts in the market believe that medicine optimisation has the potential to trim the costs of long term conditions as well as waste levels and emergency admissions. 2
Researchers have noted that 5 – 20 % of hospital admissions are due to medicines, half of these were labelled as avoidable with support from a medicines management service. (10)
Similar to NICE, the Royal Pharmaceutical Society (RPS) has championed the task of medicine optimisation through its guidance for physicians and other industry professionals. The RPS report noted that almost a third of patients become non-adherent after only ten days of starting a prescription. In their guidance the RPS highlighted four key touch points that healthcare professionals should master when preventing patients from taking medication inappropriately.
1. Understand the patient’s experience. Consulting the end user where possible to assist with the clarification.
2. Evidence based choice of medicines – in terms of efficacy and cost-efficiency.
3. Adequately communicating safety guidance to patients.
4. Integrate medicine optimisation into daily practice.
The UK’s NHS Clinical Commissioners have proposed the launch of Regional Medicines Optimisation Committees to assess new medicines that NICE are not reviewing and cast guidance on whether they should be locally adopted according to the cost effectiveness and efficacy of the treatments. These bodies have been warned not to operate in silos but to function as one system.
Pharma’s involvement with medicine optimisation
Pfizer concluded it is a lack of education that causes slips in medication adherence. Just under 75% of the 1500 patients it surveyed said that their poor treatment compliance is because they don’t know enough about their medication. Also, 42% of people stopped taking their prescribed medicines without consulting a medical expert.
Pharma firms need to ensure that when they are communicating and educating patients in a compliant manner that they don’t make the situation worse by generating confusion. A recent study found that nearly 87% of physicians observed patient confusion from pharma direct to consumer (DTC) advertisements. Data showed that the estimated $5.4 billion DTC-ad spend in the US helps to enable a more aware and engaged patient, sparking important dialogues with healthcare providers. Physicians in InCrowd's microsurvey reported receiving three times the number of questions as a result of DTC ads than five years ago—from an average of one question a week to three a week.
Yet patient questions are often due to a lack of understanding caused by the advert. When asked if their patients generally understand the information provided by the pharmaceutical companies in advertisements, 65% said no.
UCB recently focused on the topic of medicine optimisation and the potential benefits in tailoring drug dosage levels to patients and their lifestyles ( stage of condition, whether the patient smokes, their weight, other medications they take) to maximise the efficacy of the treatment. 6
Looking specifically at Parkinsons Disease, medicine optimisation has its hurdles. Patients fail to access their treatments at the necessary times because their needs may not match the scheduled drug rounds at their health clinic. This failure can then jeopardise symptom management and so they may require more assistance with moving.
Long-term therapy medications should be accompanied with resources to support the patient with keeping track especially for critical health conditions. This could be via electronic reminders or calendar packs, to help the patient to see whether he has taken the medication on a specific day.
Indegene is among those in India helping to boost patient adherence through the use of call centres, which comply with the country's strict rules on the marketing of pharmaceutical drug products to patients.
Packaging and labelling Enhancements
Pharmaceutical packaging has a direct influence on patient compliance with medicinal therapy. One major inefficiency in today’s industry is in regards to the variety of information given to patients for one pharmaceutical. Sometimes the information provided by doctors, pharmacists and the product’s literature can differ – which could skew the usage of the medicine itself. Karel van der Waarde urged that there needs to be a focus on ensuring there are exact parallels in the information given from different sources on one product. This is especially important with patients that need to take a selection of drugs safely.
Tailor design to the safety of the end user in focus
Karel van der Waarde notes that packaging should be sufficiently aligned to the safety profile of a pharmaceutical. In regards to the medicine type…
- Highly Addictive
- Too complex to be combined with other medicines.
Also, in regards to the user type….
- Pregnant women
- Parents who need to keep the product safe from children.
- Pharmacists, physicians, doctors and professors
In regards to patient safety, Karel notes that the cases and situations of focus need to be considered and catered. This would optimise the patient’s compliance in a wide range of circumstances. Instead of producing information for a therapeutic medicine at one level, information should be aimed to be provided on varying levels and through a range of platforms and media. Of course legislation needs to accommodate for these improvements.
Also, pharma firms should consider customising the packaging to the stage of the condition at hand. Currently for those with chronic diseases, a patient could be receiving the same information about a product for 30 years. Packaging information tailored to the stage of the condition at hand could move to sustainably optimise patient compliance with medical products.
In a previous interview Tassilo Korab, Executive Director for the European Healthcare Packaging Compliance Council, explained why pharma firms should recognise the importance of investing in medicine optimisation. “A patient who doesn’t take the medication in the way it’s prescribed will not get better, or will not be able to stabilise his health condition, and therefore, he will go back to the physician, who subsequently will prescribe a different drug because obviously the first one didn’t work. That is lost turnover for the pharmaceutical industry. It is much easier for a pharmaceutical company to keep a patient on a therapy than finding new patients for that very same therapy.”