When hub services providers like CareMetx think about how to support the entire patient journey on therapy, we recognize three key phases: initiation, adherence, and persistence. Each is critical to a patient’s success on therapy and their health outcomes.
It's common for other hub providers to focus solely on the initiation phase, and to take a mostly financial perspective: tackling the benefits verification and prior authorization processes to ensure medication is accessible to a patient, enabling them to start treatment. Some go a step further, and assist with affordability by connecting patients with financial assistance programs, and helping them submit the required applications.
Efforts like these are vital to improving a drug’s initiation rate. But since persistence – staying on therapy for the prescribed treatment duration- is also highly important to therapy success, an effective hub services program needs to support patients well beyond this initial phase. That’s the philosophy behind the comprehensive, holistic approach CareMetx takes in developing patient support programs. We draw from a deep understanding of the many varied influences on patient behavior, and how to eliminate ongoing treatment barriers.
Is Persistence different from Adherence?
Persistence and adherence overlap and are highly related. Without persistence – staying on therapy for as long as prescribed – adherence is of course no longer possible. And without adherence – taking the medication correctly, at the right dose at the right time, etc. – a medication will not live up to its full efficacy potential, which can raise patient concerns about why to persist.
From a patient behavior perspective, it’s useful to think about initiation, adherence, and persistence to medication as distinct efforts. Each brings potential challenges that can make them individually harder to achieve. For example, when a medication has a complicated regimen, that may very well impact adherence. Whereas for persistence, longer term beliefs about product efficacy, the need for medication, and ongoing cost concerns are common barriers. Many barriers to medication taking behavior, whether initiation, adherence, or persistence, can be resolved by implementing proven strategies and techniques from behavioral science in all patient engagement efforts.
Patient Behaviors and Beliefs That Specifically Impact Persistence
Many different beliefs and practical barriers can influence whether a patient engages in the behaviors necessary to persist with therapy. This is especially true for patients with chronic conditions that require taking specialty medications for many years. Consider the following, and note that the italicized are illustrative examples:
- Does the patient believe they still need to take the drug? If patients are asymptomatic or experiencing mild symptoms, they may eventually question the need for a therapy that requires a commitment of time, money, and possible side effects.
- Is there an ongoing practical concern to taking the medication? If a patient consistently struggles to find transportation to a physician administered medication, they may decide stopping treatment is easier.
- Do patients believe the drug is proving effective in treating their disease or condition? If patients can’t see or experience efficacy directly, they may lose the motivation to take their medication. On the other hand, if they believe their health has improved sufficiently, they may not perceive the need to stay on therapy any longer.
- Do patients believe the drug’s side effects outweigh the health benefits? If the treatment impairs the patient’s quality of life, the risk of treatment abandonment can rise.
- Is the cost to stay on treatment too burdensome? If a patient’s insurance plan requires high deductibles and copays, over time they may feel the therapy costs are too great.
- Are patients growing tired of taking the medication for a long period? If treatment fatigue sets in, the patient may be more likely to discontinue therapy.
None of these barriers exist in isolation; in fact, for most patients, the cumulative effect of multiple challenges of this nature will trigger behaviors that keep them from refilling a script, failing to pick up a refill, or refilling a script but never taking it- whether intentionally or simply because they forget.
Impacting Patient Medication Taking Behavior
The most effective patient engagement strategy a pharmaceutical manufacturer can implement includes an early cadence of touchpoints. These enable case managers to assess a patient’s beliefs, and any barriers that could impact that patient's ability or willingness to initiate, adhere to, and stay on treatment. This knowledge provides case managers with the foundation for delivering personalized interventions and educational materials across multiple channels (like phone, text, and email for enrolled patients), and at critical points in the journey, all while leveraging key data and analytics. For instance, tracking refill activity enables a hub services provider to identify when patients are falling behind or ultimately discontinuing treatment. This allows the hub to proactively design touchpoints that intervene before this is likely to occur
By developing insights about why patients do or don’t persist on a long-term therapy, and by building personalized, data-driven journeys that address patients’ individual barriers at the most critical points, CareMetx helps manufacturers improve persistence and optimize their drug programs.
To learn how our hub services technology and patient engagement platform can help you improve persistence, along with the equally critical phases of initiation and adherence, contact CareMetx today.