Pfizer, Boehringer Ingelheim and others Use Video Games

This industry gets a lot of criticism for the price of medications, mostly based on the few examples that end up in court and make headlines. But are price hikes, in fact, a common way of preserving profitability?

Recent articles have shown that Pfizer (just to take one example) has raised the price of nearly 100 drugs by an average of 20% in the past year. While Pfizer answered queries by saying that the average net selling price, after discounts and rebates, is only 4%, this still points to a trend that needs to be addressed. The issue is made more pressing when US costs are compared to other industrialized countries, such as those in Europe, where pricing is typically lower. As we know, this often leads to consumers buying prescription drugs from a source outside of the United States. There are many factors that affect the trend. One, of course, is the sharp spike in non-adherence. According to the latest Truven Health Analytics-NPR Health Poll, as many as 67% of patients are non-adherent, up from 50% as reported in 2011 by the National Center for Biotechnology Information. Why is this becoming more of a problem? In a sort of circular pattern, cost is cited as a reason for not filling—or not refilling—a prescription. Clinical impacts, such as side effects, are another. Some patients don’t think the medication is working, and others just forget to stay with the program. As we’ve reported in these pages, non-adherence has been estimated to cause as much as a $637 billion loss for the industry. Keeping prices down may be one way of increasing adherence, and companies have pledged to do so. But how can they deal with the other issues? T he F un F actor On e way is by understanding the psychological and emotional resistance to taking medications, so that we can develop techniques for encouraging better compliance. Many companies are turning to gaming to accomplish this, on the same theory that moms use in getting kids to take their cough medicine: “Here comes the airplane—open up the hangar!” To return to Pfizer, that company recently launched Hemocraft, based on the wildly successful Minecraft series of video games. Hemocraft is aimed at younger hemophilia patients, between 8 and 16. Pfizer’s Chief Medical Officer Kevin W. Williams said “These new digital innovations can be integrated into everyday routines to help empower people with hemophilia to learn about and track different aspects relevant to their disease so that they can have informed conversations with their health care providers.” Hemocraft was created in partnership with the Entrepreneurial Game Studio at Drexel University and representatives from the hemophilia community. Players meet a village doctor to learn about their treatment plan, and face challenges to control factor levels. Will it work? Hemocraft was introduced only in June of this year, so the results aren’t yet in. But other examples serve to show that gamification is a worthwhile therapy. One of the leaders in this space is HealthPrize, which has a long list of case histories showing the success of the technique.

One project for Boehringer Ingelheim was a support program for patients taking Spiriva Respimat, its COPD treatment. It was called RespiPoints, and offered rewards through a free online site. Patients would report taking Respimat, read educational information, and earn points which could be redeemed for gift cards. (If they failed to refill, they could no longer earn points.) There were also quizzes and surveys, which provided valuable feedback to BI about patient understanding, beliefs and activities—how they used the product, what they knew about their condition, how much they understood of nutritional information. The platform also tracks use of the Respimat inhaler so that each patient can see how it affects their daily life. It’s part of BI’s—and the industry’s—goal to go “beyondthe pill” into such areas as “edutainment.” I n jecting Incentive Into Diabetes H ealthPrize was also engaged by the manufacturer of an injectable diabetes medication to test the impact of applied behavioral economics, patient education and rewards on diabetes patients. The project was adapted in an iframe (a website within a website) to reside within an existing CRM program. Members received daily prompts via text message or email to report their medication taking. They earned points for selfreporting medication injections, refilling their prescriptions, taking weekly quizzes and surveys, and reading daily health tips. Points were redeemable for a variety of health-related merchandise in the Rewards Mall. Members were also eligible to win monthly leaderboard competitions and weekly sweepstakes based on their levels of engagement. All prescription fills were verified through the platform’s proprietary verification system. A total of 2,305 patients registered for the program. • The average member logged in 5 times per week and spent two minutes on the site each visit, for a monthly average time on site of 43.6 minutes. • Over 75% of all members completed the quiz and survey each week • Approximately 60% of patients read the daily health tip each day. After only eight months, the program demonstrated an incremental fill rate of 2.9 fills. At the conclusion of the program, the mean prescription fill interval (number of days from one fill to the next) was found to decrease from 57.5 days pre-enrollment to 35.1 days post-enrollment.

W iping Out Acne A leading prescription acne brand wanted to educate and engage patients to improve adherence beyond the brand’s baseline prescription fill rate of 1.3 fills per patient. The strategy was to suit the brand’s topical delivery, allowing for the variable fill intervals that result from different dosing amounts. All prescription fills were verified through the platform’s proprietary verification system. The designs and messaging were also styled

for a younger demographic and included an integrated mobile application for both Android and iOS users. Members earned points for selfreporting daily medication application, refilling their prescription, taking weekly quizzes and surveys, and opening daily “Fortune Cookies” (educational tips and trivia). Points were redeemable for a variety of gift cards and merchandise in the Rewards Mall. Members were also eligible to win monthly leaderboard competitions and weekly sweepstakes based on their levels of engagement. Various customizable prompts via email, text, and push notifications were set to keep the brand and medication-taking schedule top of mind for the member. Following an initial 30-day trial period, members were required to prove they were on therapy by using the prescription verification system.

A total of 7,800 patients registered for the program, curiously with an average age of 24 years. • The mean number of prescription fills per member for those actively engaged in the program was 4.0, nearly 3 times the brand’s baseline fill rate • The mean fill rate for all verified members was 1.8 fills per member, a 39% increase over the brand’s historic baseline • The average member logged in 2.7 times per week and spent over 2 minutes on the site each visit • A third of all members completed the quiz each week and more than 200,000 survey responses were collected from patients confirmed to be on therapy, leading to valuable insights for the brand In addition, there was interesting feedback on patient education and product use: • 73% of members believe that learning about acne helps them to be more compliant with their medications • 41% of members stated that their tube lasts 3 to 6 months, longer than anticipated by the brand • 36% of members reported that they received 3 to 5 or more product samples from their physician, which prompted the brand to review their sampling procedures. Patients with many samples demonstrate longer delays in filling the initial prescription Healthcare companies today face a Pandora’s box of challenges to profitability, from the patent cliff to the staggering costs of launching a new medication to regulatory and other stumbling blocks. Improving adherence is a promising area to pursue if we are to support a more robust industry. Wouldn’t it be interesting if fun proved to be one way out of this dilemma? •