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August 25, 2016 1

JenniferAniston-ShireShire and Digitas Health LifeBrands (the agency of record) announced a new celebrity spokesperson today, partnering with Jennifer Aniston to raise awareness and understanding of chronic dry eye. By sharing her own experiences with the condition, she hopes to “educate and inspire people” to learn and communicate more with their healthcare professional. According to the news release, the educational awareness campaign, eyelove, is “inspired by the wonderful things we can do and see because of our eyes.” As part of the campaign, NYC's High Line will host an “eyelove art project” in October, encouraging visitors to share their own stories and “[create] a unique artistic image of their eye via a customized photo capture. The photo will then be projected onto a large screen, showcasing each person’s one-of-a-kind eyelove art. Participants have the option to share their eyelove art via social media channels. People can also visit www.myeyelove.com to create their own art.”

Another component to the campaign are two unbranded television ads – one with and one without Jennifer Aniston. The ad with their celebrity spokeswoman showcases the actress discussing her own experience with dry eye before she “finally decided to show [her] eyes some love”, followed by a female voice over suggesting consumers talk with their doctors. The non-celebrity TV ad focuses on three different women, each enjoying their favorite activity, or, “the things [they] love to do with their eyes”, as a female voice over states before urging consumers to talk to their doctors.

Click here to read more about Jennifer Aniston's partnership with Shire's disease education launch campaign.

Jennifer Kovack


August 19, 2016 1

DTC spending continues to be very strong in 2016 based on a number of new brand advertisers. I fully expect the 2016 spending to top 2015 by 5% or more. That would put the total at about $5.5 billion. Driving much of the growth in 2016 will be diabetes drugs.

The number of diabetes advertisers used to be relatively small and often confined to print publications. Now many diabetes brands are all over television. There have been several new categories of diabetes drugs launched in the past few years. One is long lasting insulin for both Type 1 and Type 2 patients. Toujeo and Tresiba are the big spenders. There are also new injectables that are non-insulin that control blood sugar. Victoza is the big spender here with Trulicity in the mix. A whole new category of pills that help the kidneys excrete excess sugar burst on the scene in the past few years. Farxiga, Invokana, and Jardiance are all heavy spenders. Another new category of pills help regulate insulin after meals and these recent entrants include Onglyza, Tradjenta, and Januvia.

Bob Ehrlich
“Critics should welcome..awareness created by diabetes DTC..”
-Bob Ehrlich

Why are Diabetes drugs investing so much and launching so many new brands? The market is huge at 29 million people with diabetes. With aging baby boomers swelling the population, this market will receive heavy investment in R&D and marketing. We are also seeing an emphasis on early diagnosis by alerting people with blood sugars over 100 that they have pre-diabetes.The American Diabetes Association says there are 86 million adults with pre-diabetes. While most do not receive treatment they are increasingly made aware of the risks of developing diabetes. That early awareness should help the adoption of advertised drugs as those pre-diabetics evolve to diabetes.

There are many products on the horizon that will be launched that improve blood sugar as companies are looking for new pathways to control blood sugar. A company in Israel is developing an oral insulin which would be a welcome alternative to injections. There are many companies working on devices to test blood sugar non-invasively to replace the finger sticks.

While many DTC critics say drug companies push drugs in categories where treatment may be overused, this is hard to argue in diabetes. The CDC reports that only 57% of diagnosed diabetics have numbers under control (HbA1c under 7). Even small changes in blood sugar have a significant impact reducing complications. The advertising for all these drugs emphasizes control of blood sugar. The challenge for all these drugs is how to say control in advertising that differentiates one brand from another. With so many ads on mass media this is a category that needs continuous innovation in creative development.

Because of the significantly higher incidence among African Americans and Hispanics diabetes DTC has many opportunities for multicultural campaigns. Given the many new types of diabetes treatment pathways there is a need for education on which might be right for patients. That means fertile ground for the use of DTC for years to come. Even the DTC critics should welcome all the awareness created by diabetes DTC advertisers. The estimated annual healthcare cost of diabetes is $245 billion in America. Telling people about blood sugar control serves both societal and drug company objectives in controlling the numerous devastating complications.

Bob Ehrlich


August 12, 2016 0

In a heart wrenching story by a husband of a lung cancer patient, Opdivo DTC received harsh criticism. The op-ed in the 8/9 New York Times titled Cancer-Drug Ads vs. Cancer-Drug Reality delivers a rebuke to Opdivo for creating false expectations. The author Matt Jablow writes a touching story about his 48 year old non-smoker wife diagnosed with lung cancer who passed away in 2013.

Bob Ehrlich
“I disagree that the commercial is misleading.”
-Bob Ehrlich

Mr. Jablow recently saw the DTC ad for Opdivo and felt it was misleading in saying it could extend the lives of lung cancer patients. He goes on to say that the drug only helps 20% of patients and only a small added survival benefit measured in months. While I understand Mr. Jablow’s concern I disagree that the commercial is misleading. It says Opdivo gives you a chance to live longer vs. chemotherapy. It says the survival in the clinical study added a few months vs. chemotherapy.

I agree the ad is majestic and bold in showing a headline about a chance of living longer. An ad always features the main benefit and is designed to get you to pay attention. No patient seeing this ad will think their cancer is going to be cured by Opdivo. They will at most ask their oncologist about the potential use for their case. The oncologist will explain benefit and risk and the added survival time will be disclosed.

The idea that a patient will see this ad and have false hope is disingenuous. Any patient or family member of a patient with lung cancer is not going to read too much into the first five seconds of an ad. These patients will investigate the drug advertised and get a lot of information before using it.

We all know Opdivo wants to make patients aware of this new drug because they want to sell more of it. That is what all advertising is designed to do. Mr. Jablow thinks the ad overstates the benefit. The FDA reviewed the ad and did not agree with Mr. Jablow. Mr. Jablow wants Opdivo to withdraw the ad. What about the patients who do benefit from seeing it? While it did not apparently help his wife who was in a clinical trial, it may help someone else's wife.

I do not expect Mr. Jablow to agree with me. No one can fully understand his anguish about losing his wife and his opinion should be respected.  I think his critique is not fair, however, and the commercial is truthful and provides valuable information.

Bob Ehrlich


August 10, 2016 0

You know the ubiquitous ads soliciting clients who were “injured” by prescription drugs. Lawyers all over the country create a drumbeat of fear over prescription drug side effects. The American Medical Association(AMA) is now concerned that this fear mongering is causing patients to get off or refuse to start needed therapy. Last month the AMA called for warnings in these lawyer ads telling patients not to stop taking their meds without consulting their doctor.

The stats are amazing. About 360,000 lawyer ads were run in 2015 on drugs and devices. Many of these law firms are just bundlers who get leads from the ads and turn the names over to trial firms for a cut. The AMA has called for a ban on drug company DTC which seems odd if they are concerned about the scare tactics used by law firms. Drug ads give the positives and negatives while law firms only give negatives. One would think the AMA would want the positives out there if they fear the effects of fear based lawyer ads.

Bob Ehrlich
“FDA should conduct a study to determine affect lawyer ads have on consumer attitudes.”
-Bob Ehrlich

The most ads were run against Xarelto, with Pradaxa, Invokana, Risperdal and Androgel in the top 10. FDA should conduct a study to determine what affect lawyer ads have on consumer attitudes. While they do not regulate what lawyers say a study could help them determine how consumers react to these risk ads. That might help them determine how drug companies discuss risk.

There is no doubt some patients have legitimate claims against drug companies. Lawyers can play useful roles in protecting patients. These ads go beyond that role as they chase clients and create a climate of fear. That being said, these law firms make money doing this direct response advertising. The fact that 360,000 ads were run show they work. A Congress filled with lawyers is unlikely to hold any hearings take steps to stop these ads.

One would hope ethics would mitigate the egregious nature of these ads. Ethics are clearly not the main concern of those drumming up business by scaring patients off their meds.

Bob Ehrlich


July 20, 2016 0

July2016-RuschauArtworkOne of the first health lessons many of us ever heard was that famous rhyme our mothers used to recite frequently: An apple a day keeps the doctor away. With all due respect to mothers everywhere, while apples are a perfectly good source of nutrition and have many benefits, unfortunately we know that simply eating one every day is not enough to keep us in perfect health.

However, if you’ll indulge me for just a minute, let’s pretend that apples really could keep the doctor away. Sadly, here’s what we know would happen:

  • Roughly one-third of people who are supposed to eat an apple a day wouldn’t even go to the grocery store to buy a bag[1]
  • 75% wouldn’t eat an apple all seven days of the week, but they’d definitely try their best to eat an apple at least four or five times per week[2]
  • More than 70% of those struggling with depression would start eating apples every day, but would no longer be eating them after six months[3]
  • The grocery industry would be spending hundreds of billions of dollars per year trying to figure out why nobody wants to eat their apples[4]

Unfortunately, as we all know, we’re not talking about apples. This is the reality of the pharmaceutical world, as study after study has shown that patient adherence and compliance are two of the biggest challenges facing the industry.

You can write this off as human nature if you want. After all, people are notoriously bad at taking orders and following directions. But what if the problem isn’t that patients don’t know what they are supposed to be doing, but rather, they simply don’t understand why they should be doing it?

As a brand marketer, there’s a huge opportunity for you to go beyond the prescription pad to give patients what they want most: knowledge.

By incorporating key messages in education materials placed in the offices and exam rooms where they receive this prescription, you can go beyond simply telling the patient what they should be doing. Rather, you are showing them why they should be doing it and empower them to ask questions that truly make a difference in their health journey.

What are those questions? Here are a few to get you started (using our “apple a day” example):

  • What do I need to know about this disease/condition?
  • Why is an apple a day the right treatment option for me?
  • How is the apple a day going to improve my disease/condition?
  • Do I want a red, green, or golden apple?
  • Are there any side effects to eating an apple a day?
  • In addition to the apple per day, what are other treatment options or things I should be doing to manage this disease/condition?

And it’s not just patients who find this information helpful. As Debra Miller, M.D., from the Mapleton Medical Center in Indiana told PatientPoint, “Staff and patients really love [your] brochures because it’s easy to get the information they need. Often, I walk into the exam room and the patient has already taken a brochure and has questions ready for me.”

By planting the seeds of knowledge before the script is ever written, you encourage a meaningful conversation between patients, staff and physicians about the disease and medication options. And while telling someone to eat an apple a day may result in temporary success, showing them why it’s an effective option can produce much more fruitful results.

 

 

SOURCES:

[1] http://annals.org/article.aspx?articleid=1852865

[2] http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf

[3] http://www.medscape.com/viewarticle/818850

[4] http://www.medscape.com/viewarticle/818850

Linda Ruschau


July 20, 2016 3

The current statistics on medication adherence are remarkably somber. At the moment, lower rates of adherence translate not only into poor health outcomes which result in 125,000 deaths per year, but also healthcare costs ranging from $100 to $300 billion annually. Over the past 30 years, the WHO and Institute of Medicine (IOM) have not been able to achieve their goal of rate improvement. July2016-DiPersioArtwork1By addressing challenges associated with health beliefs, learning styles, medication regimens, and inherent changes in patient status, pharma will develop the necessary support system to increase rates. Mobile phone interventions, patient literature, and pharmacy in-person consultations are critical tools of a multi-channel approach to maximize medication adherence.

Mobile Phone Interventions

The simplest form of mobile technology which increases medication adherence is text messaging or short message system (SMS) that includes program details, therapy reminders, and motivational information. This inexpensive vehicle provides a consistent flow of enhanced daily patient communication. Targeted and personalized information is quickly and conveniently sent via mobile phone to the right people at the right time. An OptumRx study involving experimental subjects who received several different kinds of medication alerts, refills, and dosage reminders culminated in an overall medication adherence rate of 85% on the experimental side and only 77% adherence on the control side.

July2016-DiPersioArtwork2On the other hand, adherence rates are higher when using the most complex form of mobile technology that includes artificial intelligence-adapted text messages with reinforcement learning (RL). RL automatically modifies SMS communication to provide data which is tailored to current needs and also adapted to future needs as patient status changes. The customized algorithms “learn” from their interactions with patients to determine the appropriate action that optimizes total reinforcement and motivates behavioral changes. In a University of Michigan project, researchers created a RL algorithm for innovative decision making based specifically on hypertension medication bottle openings recorded via electronic medication monitoring. A database tracked patient feedback from the medication event by monitoring system cap openings and then a RL engine learned from patient experience to determine individualized messages to send at specific times.

Patient Literature

More than 95% of pharmacists believe patients who receive product-specific, easy-to-understand, and culturally relevant education brochures from the pharma industry, such as novelas with comic-book style images in the Hispanic culture, benefit from greater levels of medication adherence. However, the caveat is low literacy skills across all populations that often times result in a misunderstanding of prescription drug warning labels followed by an incorrect use of medications. The majority of prescription instruction sheets are written at a ninth grade level or above but almost 90 million Americans read below the fifth grade level.

However, patient literature is boundless in improving oral cancer drug adherence. Oral cancer medications are self-administered with patients taking charge of managing their own conditions. July2016-DiPersioArtwork3While perusing literature at their convenience during their own private time, patients not only educate themselves about their illness and the common side effects of oral chemotherapy but also develop the insight of when to seek emergency care. Literature motivates them to gain a better understanding of the condition and assume an active role in their treatment. The American Cancer Society states that some patients will not take their medications as prescribed because of depression or limited emotional support. However, further understanding the literature could motivate them to adhere to a specific regimen and view adherence as a means to well-being and a healthier outcome.

Pharmacy In-Person Consultations

Live patient counseling with pharmacists is the most effective channel for medication adherence. The tenet of “two minutes to trust building” is based on patients having a long-term healthier outcome when they are allowed to speak openly for a minimum of two minutes with free flowing conversation. At the pharmacy, patients discuss sickness more willingly and ask more questions. They are less intimidated by pharmacists than physicians partly because they do not see a huge divide in standing and do not feel a sense of inferiority.

July2016-DiPersioArtwork4A Walgreens study about a cholesterol level lowering regimen showed that patient face-to-face consultations with pharmacists result in the highest medication adherence. At the end of one year, well over 40% of the experimental group reached a target adherence rate of 80% or more, while only a little over 30% of the control group reached the same rate. Pharmacists need to be trained specifically to converse with patients about perception of therapy value, anxiety about side effects, absentmindedness, and the advantage of an established routine for medications. Prior to engaging in an effective consultation, pharmacists should complete a personalized non-adherence risk assessment which includes determining what patients know about their regimen presently, how patients can read labels correctly, their perception of efficacy and safety and the benefits of a demonstration.

In summary, medication adherence was at a standstill – until now. The old adage that talk is cheap certainly does not apply to our forward-looking pharmaceutical industry which recognizes the immense value of communication with adherence. Engaging in a multi-channel communication approach with mobile phone interventions, patient literature and pharmacy in-person consultations increases medication adherence rates, achieves healthier outcomes and lowers healthcare costs overall.

 

SOURCES:

“Improving Prescription Medicine Adherence is Key to Better Health Care.” PhRMA. (2015)

“In-Person Consultation with Pharmacist May Improve Statin Adherence.” MedTera. (2014)

“Medication Adherence Time Tool.” American College of Preventive Medicine. (2016)

Mitchell, A. J. and Selmes, T. “Why Don’t Patients Take Their Medicine? Reasons and Solutions in Psychiatry.” Royal College of Psychiatrists. (2016)

“Patient Education Brochures, Other Approaches May Improve Oral Cancer Drug Adherence.” MedTera. (2014)

admin


July 20, 2016 0

Today’s most successful adherence programs focus on the patient, not the product

doctor talking in a callcenterDeveloping successful patient adherence programs is a win on all fronts. Each year, a lack of patient adherence costs the U.S. healthcare system an estimated $290 billion. Indeed, payers benefit in the long run from reduced costs of healthier patients. Yet there are other far-reaching benefits beyond the potential billion-dollar savings. Patients who comply with medication and treatment programs often experience improved health outcomes, and these documented treatment programs can increase the amount of physician drug referrals and repeat prescriptions.

While the traditional approach to patient adherence has been a one-way street — that is, communicating to a patient about what he or she needs to do to stay on a treatment regimen — focusing on a more holistic approach that encourages conversation with the patient can greatly improve the success of your adherence programs.

This approach begins with program design. By ensuring that your program encompasses all facets of a patient’s unique healthcare situation — which includes not only the patient’s health condition and particular medication, but also the patient’s support system or caregivers, socioeconomic status, level of health literacy and other factors — you can set yourself up for success.

Let’s explore the best practices for connecting with patients and the ways you can make your adherence programs both relevant and customizable to the participants’ needs and preferences.

Step 1: Engage with the Patient

It may seem obvious, but it’s often overlooked: Your adherence program can only be as successful as the patients who are enrolled and engaged with it. That means making it easy for patients to learn more about your program and providing multiple access points for patients to register.

This step often begins with a physician. Many patients may not even be aware that these support programs and resources exist for their particular condition or while taking a certain medication. A prescribing physician can be an excellent gateway to acquiring patients for your programs who are interested and engaged from the start. Tap into this resource by reaching out to physicians who prescribe your medication, and share information and materials about the benefits of your program and the complementary support it provides to their patients. This can even prove to be a competitive differentiator. Later, once the program is underway, it’s critical to keep the communication with the physician open and to provide the physician with concise updates on the progress of a patient in a program.

By knowing your audience and recognizing the levels of engagement, you can recommend and deliver a multifaceted program that reaches the patient (as well as his or her caregiver, when necessary) and the physician.

Focusing on engagement from the start reminds us how the best adherence programs are patient-centered, not exclusively product-focused. In the next steps, we’ll explore the ways participants can help drive the conversation, and not be solely a listener, in these programs.

Step 2: Make Your Program Relevant

First things first: ditch the script. Whenever possible, your adherence program should feature applicable content delivered by flexible guides. Allowing your agents to use their own words within the guidelines of approved messaging is much more well-received by a patient than a script read word-for-word on a call.

Furthermore, have you considered the critical role your agents play in making your programs relevant? Your agents are more than message-deliverers; they are supporters, educators, and advocates, and they provide resources that are useful and helpful to each patient’s full scope of care. Consider the ways you can best match your agents with the content they deliver — for example, is healthcare background necessary? If so, would a certain healthcare specialty or other experience (such as social work or psychology) be most beneficial? Once you’ve found the appropriate match, allowing your patients and agents to develop one-to-one coaching relationships throughout the course of your program can pay dividends in improving patient satisfaction and compliance with the program.

Consider this example of a cancer adherence or support program. The nature of this type of program lends itself to having a qualified agent who is intimately familiar with the complexities of cancer care, such as an oncology nurse. While sharing the expected side effects of the treatment itself is important, it is crucial for the nurse to also become a complete resource to the patient — creating opportunities for two-way conversation in order to help the patient overcome their health challenges. That might mean answering questions or providing resources about how to cope with side effects (and directing back to the physician where appropriate), providing nutrition and stress management tips, or even assisting with the coordination of transportation or questions regarding insurance coverage.

Without a doubt, one of the key values of adherence programs that emphasize engagement is that the content itself is relatable and considers health literacy. Engagement-focused, patient-centered programs convey content in easily understandable, conversational terms; they stay fresh over the course of a program; and they empower patients to be involved in their care.

Step 3: Customize Your Program

Personalizing your adherence program can go a long way in achieving better outcomes. The program’s communications — or more specifically, the conversations that take place — should be customized to enhance engagement, increase the program’s success rates, and ultimately, improve the patient’s health.

Early on in your program, conversations with the patient can uncover personal barriers to adherence — physical, emotional, practical, or otherwise. These barriers can range from undesirable side effects (“This drug makes me feel nauseous”) to indifference (“It doesn’t matter if I really take this drug”) to cost (“I can’t afford to take this drug”). A personal relationship with the patient can allow an agent to pick up on those cues in conversation, so that these barriers can be addressed throughout the full course of the program.

Because patient side effects and adverse events can vary throughout a treatment regimen, it’s crucial for the agent to have that personal relationship with the patient so they can guide them through the treatment protocol, while also listening carefully to report key data that offers valuable insights to improve the patient’s health and, in the long run, potentially even improve the drug itself.

Once you have designed and implemented an adherence program that is engaging, relevant, and customizable to the patient, be sure to measure your program data to evaluate its success versus the developed outcomes criteria. Work with your client to understand the measures of success in their eyes. The data collected in your program can yield valuable insights to help you enhance your programs in the future.

Kevin Connolly


July 8, 2016 1

I could not leave last week’s column on media inspired patient fear without another example. The excellent New York Times reporter Gina Kolata did a story on patients resisting drug treatment for osteoporosis out of side effect fears. The story in the June 1 New York Times said millions of people were forgoing osteoporosis drugs out of fear from exceedingly rare side effects.

Ms. Kolata highlights the problems doctors are having convincing patients who need drugs to start therapy. Use of these drugs has gone down by 50%. The incidence of broken thighbone side effects is 10-40 patients for every 100,000 and one in 100,000 for broken jawbones. This means millions of sufferers of osteoporosis are needlessly suffering fractures because they fear side effects.

Bob Ehrlich
“FDA needs …much better guidance on quantifying risk.”
-Bob Ehrlich

Who is to blame? The media reports are partially to blame because they do not give the minuscule odds of a side effect compared to the effects of non-treatment. Lawyers are to blame fishing for patients who take these drugs and claim side effects. How many commercials do we see from lawyers listing a litany of drugs that may have caused side effects?

The FDA is to blame for requiring these extremely rare side effects be part of the ads. While every patient should know the risks, saying fatality in an ad without context is a disservice to patients. What we need is a reporting of the odds of a serious side effect, not vague terms like rare. Consumers will overstate the odds if they hear the word death in an ad. I doubt too many consumers would avoid a drug with a one in a 100,000 incidence. To consumers, words like rare could mean 1/100 not 1/100,000.

FDA needs to have a much better guidance on quantifying risk. Serious risks require clear quantitative odds of occurrence. Patients deserve it. The media should also be held to a high standard when doing their sensationalist stories on drug risk. As this article reports, scared patients make irrational risk/benefit decisions.

Bob Ehrlich


June 24, 2016 0

The AHSP, the organization that represents 43,000 pharmacists and technicians in hospitals and other acute care settings, called for banning DTC. This was a change from previous positions that supported DTC in limited use. The AHSP does not represent retail pharmacy but it is still an important voice in health care. Along with the AMA this call for a ban adds fuel to the political fire related to drug company bashing over pricing and marketing.

Bob Ehrlich
“The AHSP..cites.. much misstated data on drug marketing..”
-Bob Ehrlich

The AHSP statement calling for a ban cites the much misstated data that says drug companies spend more on marketing than research. They also say that DTC can be misleading. Therefore they feel that pharmacists and other clinicians can best help consumers with drug selection. This reasoning is faulty. Drug company marketing data includes sales force expense, sampling costs, physician ads, as well as DTC. The drug companies spend over $50 billion on R&D. That is ten times the amount spent on DTC.
Are drug ads misleading? FDA requires all claims to be clinically supported and requires fair balance. They review all ads for accuracy. While advertising is designed to sell, drug ads are the most scrutinized of all advertising categories.
Despite the facts, the anti DTC forces are a major concern for drug advertisers. Hilary and Trump are not friends of the drug industry. It is clear from their statements that neither has their facts straight. Hilary sees drug companies as her enemy, an evil profit hungry industry. Trump sees drug companies as one of his vendors to be squeezed like a mattress supplier for his hotels.
What drug company employees and their media and agency partners must do is let Congress know the facts. Take the time to educate your Congressional representatives how important drug advertising is and why it is important to consumers. Have them understand that DTC does not raise prices. Banning commercial speech for lawful products is a bad idea. What category will be next?
The call for a ban by hospital pharmacists is hypocritical given the huge investment hospitals are making in DTC. Almost every hospital advertises these days. These same hospital based pharmacists think it is acceptable to advertise surgery on television but not drugs.
DTC advertising is not perfect but deserves to be one way for patients to get information. If pharmacists think banning information helps patients, they are wrong. Their input is valuable but to say they and the physician should have a monopoly on patient communication is unrealistic in the Internet era.

Bob Ehrlich