Public debate regarding pharmaceutical advertising intensifies as direct-to-consumer spending continues to escalate. But while the controversy focuses primarily on DTC tactics and how effective they are, patient noncompliance — estimated to range from 30 to 50 percent — severely undermines the potential financial and public health impact of DTC advertising. In other words, while these ad campaigns — according to recent Prevention magazine and Harvard School of Public Health studies — have been successful in driving patients to the doctor and securing Rx drug prescriptions, they do little to encourage patient compliance with prescribed therapies.
As with any consumer brand promotion, attracting consumers to the brand and encouraging trial is not sufficient to assure brand success. Moving beyond this attraction and trial phase of the to building and sustaining relationships –bonding the consumer to the brand — is critical to maximize full brand potential.
Relationship marketing programs further provide a unique opportunity to address and overcome individual patient barriers to compliance, thereby improving overall compliance and patient health while increasing pharmaceutical sales. In addition, Rx drugs for chronic health conditions are perfectly suited for ongoing relationship marketing programs because of the long-term, and in some cases lifetime, nature of the disease.
The lion's share of the DTC investment is skewed toward motivating consumers to ask for specific drugs, not programs designed to encourage compliance. The need for these types of programs, however, is compelling. Once physicians give the patient a prescription, a significant portion of the initial prescription and refills are never even filled by the pharmacy. Based on clinical literature and clinician experience, of those prescriptions that are filled by the pharmacist, on average only one-third of patients fully comply with the prescribed treatment, another third will comply partially, and the remaining third won't comply at all.
Pharmaceutical noncompliance is not limited to non-life threatening medical conditions but includes Rx treatments for serious medical conditions like diabetes, epilepsy, chronic heart failure, cancer and HIV. Clinical studies utilizing electronic measuring devices to monitor drug compliance support these less-than-optimal compliance statistics. For example, according to the Diabetes Educator, insulin dependent diabetics have a 53 percent rate of compliance. According to the Journal of American Medical Association, epilepsy patients have a 76 percent rate of compliance. In some lifetime therapy categories like cardiovascular, patients stay on drug therapy for just six months.
The economic consequences of noncompliance are equally staggering. According to IMS America, pharmaceutical companies lost $25 billion in 1996 due to noncompliance. The Archives of Internal Medicine puts a $76.6 billion price tag on annual related morbidity and mortality costs including workplace productivity. Hospitals alone spend $8.5 billion a year due to noncompliance.
Relationship marketing programs designed to impact noncompliance must be based on solid market research and consumer insights not only to uncover and address both the mechanistic and attitudinal barriers to compliance but to truly understand the life cycle and experience of illness. Mechanistic barriers include busy lifestyle, cost and doctor avoidance. Attitudinal barriers — which are typically the real reasons behind noncompliance — can range from fear of long-term therapy or side effects to denial of the disease or health condition. For example, is suffering from allergies dealing with a stuffy nose or a loss of freedom? Is arrhythmia skipped heartbeats or the ever-present threat of sudden death? Is menopause dealing with hot flashes or a change in identity?
Why patients are noncompliant is as unique to the individual patient as it is to the drug category. Developing messages to effectively counteract those barriers requires extensive effort, research and testing.
As the marketing of Rx brands matures and continues to evolve, increased attention will be focused on the financial and healthcare implications of pharmaceutical noncompliance. The implications of a more integrated, balanced approach to moving consumers beyond brand attraction and trial will not only increase pharmaceutical sales but will have a corresponding impact on improving patient health and satisfaction and reducing the social cost of noncompliance.