Choosing Between Food and Medicine
The COVID-19 induced recession has taken another ominous turn as the Census Bureau recently reported that almost 30 million Americans responded in a survey that they did not have enough food to eat at some point during the week before July 21 . A record number of people are also going to food banks . The reason for this situation is the combination of COVID-19 mandated shutdowns with their resulting effects and the economic consequences from high unemployment generated from these business closures. This turn of events is not surprising as similar effects were seen during the Great Recession of 2007-2009. The economic fallout from the COVID-19 induced recession is much more severe, with the unemployment rate still above 10% (the Bureau of Labor Statistics reported a 10.2% rate for July 2020) . This means people are increasingly having to make tough choices about where to spend scarce dollars for necessity items like food, medicine, rent/mortgage, or essential utility bills.
Why should pharma companies be concerned? Evidence from the Great Recession revealed people discontinued taking their medications. For example, people stopped taking their hypertension and diabetes medications . The combination of the economic fallout from the Great Recession (market access and affordability effects) and the asymptomatic nature of hypertension and diabetes are the strongest factors at work. Older patients must choose between being adherent to multiple medications. Medications for asymptomatic conditions are likely to be discontinued in favor of those that treat symptomatic conditions, even though chronic diseases like hypertension and diabetes are more critical to medicate than, say, osteoarthritis of the knee. There is a long body of health services research literature documenting that people generally make suboptimal healthcare choices. Figure 1 summarizes recessionary effects on decreases in branded and biologic drug utilization.
Figure 1. Market Access, Plan Control/Design, Affordability, and Government Control Reactions to Recessionary Effects on Drug Utilization
Source: Axtria Inc.
Recession Effects on Patient Health Outcomes
Figure 2. Market Access, Plan Control/Design, Affordability, and Government Control Reactions to Recessionary Effects on Overall Drug Utilization and Patient Health Outcomes
Source: Axtria Inc.
Not surprisingly, there is also growing evidence on the long-term consequences to patient health (especially on mental health) from the Great Recession due to these effects . Figure 2 outlines the effects of a severe recession on patient health outcomes. The economic and healthcare-access effects from the COVID-19 contagion and induced recession are expected to be much more severe on patient health. Aside from market access and affordability effects, patient-physician engagements have been affected as people are afraid to go to their doctor offices. An increase in virtual telehealth physician-patient engagements can mitigate this effect, though the long-term consequences remain to be seen and measured. People have also delayed important diagnostic tests or elective surgeries for conditions that could become more severe if left unattended over time. So, while the long-term consequences to patient health are still unknown, it is important for pharma companies to understand, predict, and take steps to mitigate such effects that are drug utilization-related and thus under their control.
Pharma Company Actions to Mitigate Patient Health Outcome EffectsThe following five company actions can be taken to mitigate adverse pharmaceutical-related patient health outcome effects caused by a COVID-19 induced recession through reducing drug utilization.
- Understand managed market effects, through changes in market access, plan control/design, and government control/Medicaid
- Analyze how contracting efforts will be critical in reducing co-pay issues for patients and restrictions placed on physicians to prescribe branded/biologic drugs.
- Generate analytical modeling to determine how plan control/design changes will affect physician prescribing away from branded/biologic drugs that can produce lower patient health outcome effects, and in turn, reduce health outcomes.
- Apply health economics and outcomes research (HEOR) and real-world evidence (RWE) modeling to leverage patient-level claims and electronic health records to elicit adverse health outcome effects through changes in plan design/controls.
- Develop HEOR and RWE model designs and empirical analyses to demonstrate the value of new specialty medicines, especially in oncology. The industry will see an acceleration of the use of health technology assessments (HTAs), as employed by The Institute for Clinical and Economic Review (ICER), to challenge drug pricing.
- Use coupons, co-pay cards, and vouchers to mitigate affordability issues brought about by severe local economic conditions. Empirical analyses must be applied to determine their economic rationale through maintaining drug utilization via patient adherence, and in turn, produce health outcome benefits.
- Apply artificial intelligence (AI) and machine learning (ML) to predict in real-time future local economic conditions. Severe economic conditions in urban geographic areas are likely to see greater adverse economic effects on patient health outcomes per the preceding mechanisms affecting drug utilization. These urban-specific effects require companies to develop sub-national modeling techniques to estimate and forecast local dynamics.
- Develop sales, marketing, and patient-oriented approaches to ensure physicians and patients receive necessary drug information and assistance that will improve long-term patient adherence.
- Employ an omnichannel, as opposed to a multichannel approach to customer engagement.
- Ensure the sales force disseminates valuable scientific, clinical, and medical information to HCPs needed to improve the treatment of their patients. This means leveraging medical science liaisons (MSLs) and key opinion leaders (KOLs) to demonstrate drug value and benefits relative to risk.
- Create the capability for sales reps to offer indirect engagements with HCPs via digital technologies, while ensuring those connections are measured and analyzed for drug utilization and health outcome effectiveness.
- Use non-personal promotion channels, such as direct-to-consumer advertising (DTCA), via all mediums and search engine capabilities to help with information search to inform patients/caregivers about the value of taking their medicines and availability of programs to help with lowering out of pocket (OOP) costs. Direct-to-patient advertising (DTPA) done in physician offices should be employed, but once people are feeling more comfortable seeing their doctor.
- Make it easier for patients to receive 90-day prescriptions to maintain/improve drug adherence. This means, where possible, make drugs available via mail order.
- Promote to patients the benefits of enrolling in a disease management program to give them needed information to manage effectively their disease and the importance of proper compliance and adherence necessary to receive full indicated drug benefits.
- Allow samples to be allocated as a way for physicians to encourage trial usage for patients who are not achieving desired clinical endpoints. However, caution should be exercised in allowing sales reps to use samples for simply gaining HCP access (sales training can minimize this behavior) and engaging in over-sampling resulting in cannibalization of prescriptions.
- Create a robust analytical capability to produce actionable business insights on the preceding research questions and topics. Proper analysis of these questions/topics requires crossing traditional siloed pharmaceutical functions. The use of analytics can bring about needed interdisciplinary insights and solutions into these problems and help with cross-functional alignment when it comes to execution.
- Develop an efficient data management structure and ability to link databases to enable cross-function analyses on the preceding research questions and topics. Databases used in the analysis of health outcomes are fundamentally different than those employed in traditional pharma commercial analytics. Effective linking of these databases will be required to create a more complete picture and determine how traditional commercial channels can affect patient health outcomes.
The COVID-19 induced recession has created economic and related societal effects not seen since the Great Depression. Recovery from the recession has also taken much longer than originally thought . Axtria has the expertise in all aspects of pharma analytics, commercial operations, and business information management to address patient issues related to economic distress, which, in turn, will decrease future patient health outcomes. Axtria would be delighted to help and ensure that your brands are properly optimized during these challenging times. This will allow us to ensure that potentially life-saving medications continue to get to the appropriate patients and mitigate the negative health outcome effects that the pandemic-induced recession will trigger.
- Andone D. Nearly 30 million Americans told the Census Bureau they didn’t have enough to eat last week. CNN, published online 31 July 2020, available at https://www.cnn.com/2020/07/31/us/food-insecurity-30-million-census-survey/index.html.
- S. Department of Labor. The employment situation – July 2020. Bureau of Labor Statistics, published online 7 August 2020, available at https://www.bls.gov/news.release/pdf/empsit.pdf.
- Sheridan K. Another fallout from the Great Recession: fewer people took their blood pressure and diabetes medications. STAT, published online 12 March 2018, available at https://www.statnews.com/2018/03/12/great-recession-medicine-blood-pressure/.
- Margerison-Zilko C, Goldman-Mellon S, Falconi A, et al. Health impacts of the Great Recession: a critical review. Current Epidemiology Reports 2016; 3: 81-91.
- Naphade K. How will the accordion effect impact your brand performance in Q4-2020 and Q1-2021. Axtria Blogs, published online 1 July 2020, available at https://insights.axtria.com/blog/how-will-the-accordion-effect-impact-your-brand-performance-in-q4-2020-and-q1-2021