Increasing ROI
through Adherence
August, 2013
Troy Johnson | Senior Analytic Consultant
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
Background
Patient non-adherence to medication is a serious issue in the US, with various estimates putting
this number between 20 and 30 percent of prescriptions never being filled. There are numerous
reasons for the shortfall, and cost certainly ranks high among them (Edmonson, 2008). Co-Pay card
solutions have emerged as an important aspect in the fight against patient non-adherence, and
represent an increasing amount of pharmaceutical spending. Because of the need for increased
patient adherence to medication and the need to wisely allocate marketing dollars in the
pharmaceutical industry, this study will discuss the most effective use of co-pay cards as a marketing
tool to provide discounts to patients to increase patient adherence. Once these attributes are
discovered, they can be used to design more effective campaigns.
Each co-pay card campaign consists of several different attributes: the card can be a physical paper
card or a physical plastic card, it can be an online offer, and it can contain different financial incentives.
The redemption attributes of the card can differ as well: different areas of the country, pharmacies,
and general demographic information on the patients who redeem offers are captured.
Our analysis consists of just under 650,000 transaction records across 12 different co-pay card
marketing campaigns within the same therapeutic class to determine which properties of campaigns
make them successful. All drugs have similar usage indications and are dispensed in similar quantities.
The data was then cleansed to include only the final transaction per patient; in other words, the
analysis studies behavior at the patient level, not the transaction level. Finally, dummy variables
were applied where necessary and the data was exported to SAS Enterprise Guide for analysis.
Linear regression, binary logistic regression, and cluster analysis were performed to analyze the data.
Results
Redemption count is the number of redemptions (or fills) per patient and is the indicator of adherence.
With “redemption count” as the dependent variable and all other values as independent variables,
factors that lead to increased or decreased redemptions were analyzed as follows. The cutoff
significance level was 10%, and multicollinearity was tested to ensure that independent variables
are not highly correlated and are truly independent. The results were confirmed by running linear
regressions and binary logistic regressions.
Odds Analysis: Positive Factors that increased adherence
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
Physical Attributes of cards
Card Language:
Co-pay cards can come in various language on the front of the card, with two of the most common
being “Pay No More Than” or “Save Up To.” For example, an offer may entice the patient to Pay No
More Than $20 for their medication or it can offer them to Save up to $50. We saw significant
differences in redemption rates based on this choice of language, with “Pay No More Than” language
leading to a 31% improvement in subsequent fills over “Save Up To” language.
Paper or Plastic?
Plastic cards were 49% more likely to lead to subsequent redemptions than paper cards in the
study. The patient may perceive a higher quality difference with a plastic card over a paper card
and be more likely to continue to redeem the offer.
Online
Online offers lead to increased adherence over printed offers by just under 20%. Intuitively, this
conclusion makes sense, as patients downloading online offers are proactively seeking out
discounts. Printed offers distributed through doctor’s offices are handed to patients who may
not have any interest in using the offer.
Financial Considerations
Surprisingly, financial aspects of co-pay card programs had little effect on patient adherence in
the study.
Card Value
Higher card values result in slightly increased adherence. For example, a card that promises a patient
pays $35 did better than a card that promises a patient pays only $20. This result is unexpected,
because a lower card value should result in increased adherence. However, remaining out of
pocket helps explain why this happened.
Remaining out of Pocket:
Some card offers are capped at a maximum benefit, and the patient may actually pay more than
the card promises. A lower remaining out of pocket amount results in slightly increased adherence.
As contrasted with the card value, the less the patient actually pays is more important to increased
adherence, as opposed to what the card says the patient will pay.
Offer Value
The offer value is how much the pharmaceutical company pays for the patient each time the card
is redeemed. We again have unexpected results, with a lower offer value resulting in slightly increased
adherence. In other words, the more the pharmaceutical company pays on the patient’s behalf,
the less the patient redeems the offer. This leads to the conclusion that patients are generally
unaware of the true cost of their medication.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
Demographic Information
Patient Age
Specific age groups fared better in the study than others, and in general, older patients had increased
adherence as compared to younger patients.
Gender
While more female patients redeemed initial offers, male patients display increased adherence
by redeeming subsequent offers. In fact, males were 30% more likely than females to redeem
subsequent offers.
Geographic Region
The Midwest region has increased adherence rates compared to the rest of the country, followed
by the West, Northeast, and South.
Adherence by zip code. Zip codes in red have higher adherence, blue have lower adherence.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
Pharmacy
The top five pharmacies by total redemptions were identified and compared to each other and to
all other pharmacies (called Independents/Others in the study). Three of the five pharmacies led
to decreased adherence rates than all other pharmacies. These three, in order of worst to best
adherence rates, were Walgreens, Walmart, Rite-Aid. The other two of the top five pharmacies,
Target and CVS, were not significant. Thus, the regression results provide only areas for improvement,
as the largest pharmacy chains are overwhelmingly the most popular with patients. We cannot
suggest to patients that they visit smaller pharmacies, as this is not a viable solution. Instead, the
larger pharmacies, such as Walgreens, should be visited by sales representatives in order to increase
adherence rates.
The pharmacy by region information gives us valuable insight as well, as we can see which pharmacies
have larger redemption amounts in certain areas of the country, which will allow us to focus on
those pharmacies in those regions to increase adherence rates. While the South had the most
redemptions overall and thus has a higher share of most pharmacies, we see that Rite-Aid has
considerable clout in the Northeast and West. We see Target and Walgreens do well in the Midwest,
which is our best area for adherence. Of course, we cannot ignore that Wal-Mart is the overwhelming
favorite in the South, giving us an area to focus to improve adherence rates.
Pharmacy by region
Looking at pharmacy redemption habits by gender, females were more likely to fill their prescriptions
at Target, and males were more likely to fill their prescriptions at independent pharmacies. Because
males have higher adherence rates, and Independent/Other pharmacies have higher adherence
rates, this provides valuable information for segmentation purposes.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
Conclusion
Offer Production
The results clearly show that when considering the physical attributes of producing offers, plastic
cards and online offers should be pursued, as these types of offers lead to increased redemptions.
The durability of a plastic card over a paper card (and potentially the perceived higher value from
the patient’s perspective of the plastic card) is important to the patient. Online offers lead to increased
adherence, likely because this is an offer that the patient is actively seeking. The language that the
card uses also has an effect on adherence, with “Pay No More Than” strongly preferred by patients.
Surprisingly, the printed card value and other financial considerations only have little impact on
patient adherence. Overall, the ideal offer produced would be a combination of an online offer
with physical plastic cards, and a reasonable co-pay amount that does not leave the patient with a
surprise when the actual amount they pay is more than the card advertises.
Offer Distribution
Where should sales representative distribute the offers? Clearly, the Midwest offers the best
chance for increased adherence rates. Other areas of the country offer chances for improvement,
so sales representatives can focus on those areas, specifically the South, to try to increase
adherence rates.
Offer Targeting
There are other attributes of patients that cannot be controlled directly by the marketing campaign,
but can be used as a source of education, so that offer distribution is skewed toward patients who
have the best chance of using the offers. From the regression results, older males with insurance
that covers their medication seem to be the highest redeemers of subsequent offers. Other
demographic groups can be addressed to provide an opportunity for education and improvement
on redemption values.
Limitations
The data consisted of marketing campaigns within the same therapeutic class, and was not
representative of the industry as a whole. While the results indicate marketing steps to take for
this therapeutic class, more data analysis would need to be performed on each therapeutic class
separately in order to obtain accurate results.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
References
Boken, Mike. “Coupons Vs. Samples.” Medical Marketing & Media 44.5 (2009): 51-53. 11 Apr. 2012.
Bhutada, Cook, and Perri , “Consumers Responses to Coupons in Direct-to-Consumer Advertising
of Prescription Drugs.” Health Marketing Quarterly, ISSN 0735-9683, 10/2009, Volume 26, Issue 4,
333 – 346.
Edmondson, Michael. “Coupons, Vouchers, and Adjudicated-Debit Cards…: How Is a Brand
Manager to Decide?” Pharmaceutical Executive, Mar2008 Supplement, Vol. 28, p38-40, 3p.
Füsun F. Gönül, Franklin J. Carter Jr, (2012),”Estimation of promotional strategies for newer vs older
drugs based on physician prescribing data”, International Journal of Pharmaceutical and Healthcare
Marketing, Vol. 6 Iss: 1 pp. 39 – 54.
Hoovers Company Information. http://subscriber.hoovers.com.prox.lib.ncsu.edu/H/home/index.
html Apr 11 2012.
Smith, Stephen J., and Paul Buta. “Clipping Coupons.” Pharmaceutical Executive 24.4 (2004): 86-92.
TrialCard web site. http://www.trialcard.com. Apr 11. 2012.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com
C:93% M:62% Y: 8% K:1%
Increasing ROI through Adherence
About TrialCard Incorporated
TrialCard Incorporated provides a comprehensive portfolio of
Marketing for Patient Access, Prescription Abandonment, Hub/
Reimbursement, Analytics, and Customer Experience Management.
Since opening its doors in 2001, TrialCard has been awarded
nine patents related to the processing and marketing of patient
access programs. TrialCard is the largest provider of patient access
programs in the industry, processing over $1 billion in patient
benefits per year to help brand manufactures achieve their
goals with prescribers, patients, and pharmacists.
For more information on TrialCard, please visit www.trialcard.com.
Contact: Joe Abdalla, R.Ph. - Chief Commercial Officer | joseph.abdalla@trialcard.com | 919-415-3103 | trialcard.com