Should Pharma Pay Patients?

Paying patients to take their medicine. It may sound crazy, it may freak out compliance folks, but apparently it works. As previously reported by Word on Health, one -third to one-half of all patients do not take their medication as prescribed, and up to one-quarter never fill their prescriptions. These lapses cost more than $100 billion dollars annually because those patients often get sicker.

To combat this, both the US and Europe, have begun to use financial incentives to improve patient adherence. Here in the US, insurance companies have started to fund incentive schemes as they have found it costs them less in the long run if medication adherence improves. Last year, the New York Times published an article advocating the use of incentives to improve adherence. They cited a successful Philadelphia program whereby people prescribed the blood-thinner drug warfarin could win $10 or $100 each day they took the drug. A computerized Informedix Med-eMonitor pillbox recorded if they took the medicine and whether they won that day. Among patients enrolled in the program, the average amount of incorrectly taken pills or missed pills dropped from 22% to 2.3%.

Another study at Queen Mary’s hospital in London looked at the effect of incentives on the adherence of schizophrenia patients. Investigators found that offering financial incentives increased adherence, improved health and social outcomes and prevented rehospitalizations in 4 out of 5 patients. Preventing re-hospitalization saves a vast amount of money and is far better for the patient.

But, is paying patients really the answer? Maybe not.  A review of patient targeted incentives by The Health Care Foundation concluded that, while “financial incentives can work to bring about discrete, one-off changes in patient behavior…there is insufficient evidence to say that financial incentives can affect complex behavior change, although there is some evidence for temporary improvements.” The key words here are ‘one-off’ and ‘temporary’ – this is a short-term solution, not long-term. In both the aforementioned studies adherence went back down after the incentives finished.  In the study at Queen Mary’s, lead investigator and psychiatry professor Dr. Stefan Priebe admitted that, for most patients, you would probably have to keep the incentive going. The Philadelphia study showed similar results. However, given the potential long-term savings, if payments must continue indefinitely, Dr. Kevin Volpp said “it wouldn’t necessarily be a bad thing.”

So, is there another option? In 2004, Malotte et al. constructed one of the only incentive experiments that simultaneously looked at other methods of improving adherence. They compared different  methods to increase repeat testing in persons treated for gonorrhoea and/or chlamydia at sexually transmitted disease clinics. The results suggested that monetary incentive did not increase return rates. In this study, a reminder telephone call was the most effective intervention.

Although financial incentives work, they are not a realistic long-term solution. Better communication and patient empowerment appears to be the key. Find out how SRxA’s team of Health Outcomes specialists can improve your adherence programs.