Technology is widely used to “automate some or all adherence programs, thereby getting better results at lower overall cost;” traditional intervention methods are not very commonly used. There are two aspects to the use of technology in medication adherence: predicting patient behavior using analytics and AI and establishing communication using digital technologies. Broadly, three strategies are used to improve medication adherence: forgetfulness and behavioral modification, care coordination and medication fulfillment, and cost reduction. This report includes examples of all three types of strategies and a variety of technologies used in medication adherence programs of health plans, pharmaceutical companies, and pharmacies.
1. Anonymous Health Plan (RxAnte)
- Pennsylvania’s CHIP/Medicaid program spent nearly $13 million in “asthma-related emergency department visits” in 2010, the fifth-most among fifty states in the US. A health plan (based in the state) adopted RxAnte’s predictive analytics-based clinical program to telephonically intervene and improve medication adherence.
- “Nearly 20,000 of the health plan’s members received controller medications, and RxAnte was able to identify 2,265 who were at risk for non-adherence. These members were selected to be called by a clinical pharmacist and their data was used to create a baseline for overall adherence. When called, the pharmacist explained implications of non-adherence to patients, educated them on proper medication usage, and assessed the patient’s health in the process.”
- The nearly 20,000 health plan members who received controller medications were aged 5-64 and had persistent asthma. As per the HEDIS Medication Management for People with Asthma (MMA) measure, “only those patients with prescribed controller medications who remained on those medications for at least 75% of their treatment period were selected for intervention. Predictive analytics assessed data related to member demographics, pharmacy, and medical history, cross-referenced with medical and pharmacy claims data, to accurately identify the target population” for outreach.
- “The CPP pilot lasted eight months, from April through December 2017. Nearly half of targeted members were reached and year-end rates of adherence did improve compared to the baseline, most prominently among those who were receptive to clinical intervention. Estimated adherence improvement for members who had a discussion with a pharmacist versus those not reached was 8.6%,” as illustrated in the figure below.
- Similarly, Blue Cross Blue Shield North Carolina availed the services of Allazo Health’s predictive analytics and AI and witnessed a 5.45 times uplift in adherence.
2. Novo Nordisk (Sempre Health)
- According to the Kaiser Family Foundation, in 2019, “29% of Americans failed to take their medications as prescribed because of the cost, with about 19% of respondents saying they did not fill the prescription and 12% saying they cut pills in half or skipped a dose.”
- Making affordability worse, over “100 manufacturers raised the price for 619 brand-name drugs by an average of 5.2% in January 2020.” A few companies have devised cost reduction strategies to enable better medication adherence.
- Novo Nordisk, for example, has a collaboration with Sempre Health, “a medication management startup that has the goal of boosting adherence by incentivizing patients with discounts on prescription medication.”
- “Sempre’s technology involves transmitting a text message to users. People receive a text message that offers a discount if they pick up their prescription on a certain day. When patients fill their scrip, they receive the discount. However, the way that discount is applied can take different forms, depending on the health plan partner.”
- The collaboration with Novo Nordisk focuses on diabetes medication from the drug developer. 10,000 patients were onboarded for the program in the first year.
3. GSK (Propeller Health)
- “In respiratory care, medication is primarily delivered through inhalers. Studies show that 50% of all patients fail to take their daily medication as prescribed. Monitoring the correctness of the drug delivery technique, as well as tracking whether the patient is adhering to the prescribed regimen is vital to improving the effectiveness of respiratory care pathways.”
- Propeller Health, a mobile platform that supports respiratory health management, developed “sensors that are designed to work with” GlaxoSmithKline’s inhaler, ELLIPTA. The company received FDA clearances allowing it to market “its new devices as improving — not just tracking — medication adherence.”
- The Propeller platform uses a multi-dimensional feedback system that includes audio-visual medication reminders on the devices, “in-app notifications, SMS, and even follow-up from the clinical support team to support adherence.”
- “The Propeller platform has been used by patients and physicians in over 55 commercial programs across the United States, including major healthcare systems, payers, employers, and other commercial partners.” Novartis and Boehringer Ingelheim are two other inhaler manufacturers that have used the Propller platform.
- “Propeller Health’s clinically validated solutions have demonstrated a 58% improvement in medication adherence, a 48% increase in symptom-free days, and a 53% reduction in emergency room visits.”
- AstraZeneca’s SmartTouch for Symbicort connected inhaler is similar to the Propeller platform. “The device grafts onto a patient’s inhaler to monitor and encourage medication adherence as part of a self-management plan. It has three buttons that help patients access the audio visual-reminders, battery monitoring, and Bluetooth low-energy pairing features.”
- Similarly, Teva Pharma has partnered (and acquired) with Gecko Health Innovations, the company behind the CareTRx platform (sensors and cloud software). “CareTrx provides dose-tracking and reminder features for one of the most common types of inhalers, metered-dose inhalers (MDIs), along with intuitive applications and cloud-connected technology to improve patient adherence and enabling data-sharing between patients and their healthcare providers.”
4. Pfizer (Mabu)
- “Pfizer and Catalia Health have launched a year-long pilot scheme exploring how patients engage with robot companions that use artificial intelligence (AI) to check on symptom management and help with medication adherence. The 12-month pilot uses the Mabu Wellness Coach, a robot that uses AI to gather insights into symptom management and medication adherence trends in select consumers.”
- Pfizer already texts its “patients’ phones to remind them to take their medication” and is also “investing in ‘ingestible trackers‘ to track patients’ drug intake.
- Mabu provides “reminders and other alerts to a user’s phone, as well as monitors how the patient is feeling on a day-to-day basis. The Mabu Care Insights Platform then delivers detailed data and insights to clinicians at a specialty pharmacy provider organization to help human caregivers initiate timely and appropriate outreach to the consumer.”
- According to Cory Kidd, founder of Catalia Health, “face to face is much more effective at creating engagement versus something on a [smartphone] screen. When you use a robot, a physical thing that has eyes and can make eye contact and use some other social cues, it’s much more effective at creating engagement with patients over time.”
- “While the Mabu has a face and eyes for engaging with patients, the design team also added interfaces such as voice response/activation, as well as a tablet to let users interact via touchscreen. ‘Many of our patients are older, and voice interfaces work pretty well, but they’re not perfect and it’s not necessarily easy to initially understand them,’ said Kidd. In adding the screen, the question that Mabu is asking via voice can be seen on the screen, and users can respond either by speaking or touching a button on the screen.”
5. A Leading Diabetes Medication Brand (HealthPrize)
- Managing diabetes can be challenging as it involves regular monitoring of blood glucose levels, taking medications on time, following a healthy diet, and exercising. “Adherence rates to diabetes medications average just 53%.”
- “A leading injectable diabetes medication franchise partnered with HealthPrize to develop an adherence and education program targeted toward the unique needs of patients with diabetes in order to support improved outcomes.”
- The program — integrated into the brand’s existing patient support portal that offered, among other resources, nurse educators and coaches — utilized HealthPrize’s approach of using gamification, behavioral economics and loyalty marketing best practices to help patients develop the routines and habits needed to manage their medications on a day-to-day basis.
- “In the HealthPrize program, patients verified to be prescribed to the brand engaged daily with educational content and behavioral triggers that supported improved medication adherence. Members received daily prompts via text message or email to report their medication taking. They earned redeemable points for self-reporting medication injections, refilling their prescriptions, taking weekly quizzes and surveys, and reading daily health tips. “
- “Members were also eligible to win monthly leader board competitions and weekly sweepstakes based on their levels of engagement. All prescription fills were verified through HealthPrize’s proprietary verification system.” Other than HealthPrize, brands such as Johnson & Johnson and Sanofi have also launched gaming apps to enable medication adherence.
- “The HealthPrize program delivered a 2.9 incremental fill increase, representing a 57% lift in adherence, in 2,309 patients verified to be on the brand’s medication. 96% of patients reported that they would miss the program after it ended. Over 75% of patients completed weekly educational quizzes and surveys, and 60% of patients read the health tips daily.”
- Additionally, HealthPrize, in collaboration with West Pharmaceuticals, has also developed programs that comprise an “electronic drug delivery system that tracks when patients take their medication and reward them with points when they meet their goals.”
- Similarly, Novo Nordisk’s connected pen technology is integrated with Roche’s mySugr digital solution easing the “day-to-day burden of disease management.”
6. Boehringer Ingelheim (MediSafe)
- Boehringer Ingelheim has partnered with MediSafe for its oral anticoagulant, Pradaxa.
- “Medisafe offers a wraparound app experience that incorporates Pradaxa-specific educational information into a special version of its app, which Pradaxa patients are directed to when they’re prescribed the drug.”
- “Pradaxa patients have access to all the normal Medisafe features, including adherence tracking, alerts, biometric tracking, and MedFriend, a service that notifies friends and family when the user is non-adherent.
- “Prescribing physicians have access to Medisafe’s physician portal, which allows them to see the patients’ adherence information.”
7. Avella Specialty Pharmacy (Adhere Tech)
- Adherence is particularly challenging for patients who take specialty medications as they involve “detailed treatment regimens, frequent side effects, varying doses schedule, detailed refill processes, higher copays, and the need for additional patient support.
- Avella uses the “Adhere Tech program for five specialty medications, in programs with four different pharmaceutical manufacturers,” with a focus on oncology.
- The Adhere Tech system (includes smart pill bottles), “in addition to sending intelligent reminders for missed doses (automated phone calls, text messages, lights, chimes, etc.), is able to determine if a patient may need additional care (personalized support for refills & health issues) via proprietary data analysis that occurs on the backend.”
- “In such an event, the system sends a real-time alert directly to an Avella nurse, who can then review the information from AdhereTech. The nurse can then decide to contact the patient to provide additional care, at the exact moment it’s needed. Patients receive this full service at no additional cost, and patient feedback is overwhelmingly positive, with the average patient satisfaction rating at 4.7 out of 5.”
- “AdhereTech has improved duration on therapy by 26%, fill rates by 9%, and dose-level adherence by 15%. On average, the AdhereTech program generates 1 to 2 additional fills of specialty medications, per patient per year.”
Top 25 Adherence Programs
- The top 25 adherence programs in the US (all tech-enabled):
- A list of medical adherence companies can also be found here.
We have provided examples of medication adherence programs that have demonstrated success. While some programs were initiated over a couple of years ago, we did not find any evidence that they have been terminated. As these programs have been successful, it is assumed that they are still being continued. Also, the number of patients enrolled or targeted in some medication adherence programs were not available in any of the industry portals, research reports, media sources, manufacturer websites, healthcare company websites, or management interviews we searched.