What $6B Could Do For Adherence?

I keep thinking about the $4-$6B that the Visante Study estimated was being spent by pharma on copay cards and how that money could drive overall adherence.

Here’s my thought:

  • If 50% of Americans are taking a chronic medication, there are ~170M people to spend this money on.
  • We can safely assume that 20-40% of this population is adherent without additional investment.
  • We therefore have 119M patients (midpoint) across which to spend $5B (midpoint).
  • This means we have about $42 per patient per year to spend on utilization.
  • Based on work I’ve participated in and work I’ve seen my clients do, I know you could raise adherence by ~10 percentage points by some simple intervention programs that would cost much less than $10 per patient per year. At the same time, there is still lots more work to be done to address primary adherence and we know that not all people are non-adherent for the same reasons or will respond to the same techniques.

    But, I’m pretty confident that the the remaining $32 per patient could fund a lot of POS interventions like Ashville, education programs, caregiver programs, incentives, and other tactics. Of course, this would float all boats (I.e., brand and generic Rxs) so the cost per manufacturer might drop and the ROI should go up. At the same time, this should create overall saving by cutting into the estimated $290B in costs associated with non-adherence.

    Of course, most people are skeptical about this type of preventative health programs (aka primary preventation or public health) although 25 of the 30 years in additional life expectancy gained over the last century is credited to public health. Additionally, the Trust for America’s Health (TFAH) had estimated that an annual $10 per person investment in disease prevention programs could produce more than $16B in annual saving within five years.

    The easy argument would be that ultimately interests aren’t aligned for pharma as prevention might reduce Rx utilization. I would hypothesize that the increased number of new starts and decrease in abandonment would more than compensate.

    Of course, how do we pull this off? I’m not sure but it seems like a great HHS opportunity.

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