Common barriers to medication adherence are cost, convenience and patients feeling better before their pills run out. What if the cost was $600 or more for a 30-day supply? What if the drug had to be administered in a physician’s office? What if there was no guarantee that the patient would get better even if he or she took the medication as prescribed?

Those are just some of the steep barriers to adherence facing patients with chronic medical illnesses who have been prescribed specialty drugs to manage their conditions or prolong their lives.

One way to overcome the barriers to specialty drug adherence is through the use of behavioral coaching.

Using behavioral coaching to improve specialty drug adherence

Behavioral coaching uses evidence-based clinical strategies and interventions to engage patients in changing their behaviors, enabling them to better manage their health and adhere to their specialty medications. Coaches are trained patient support representatives available to patients through their pharmacies or call centers operated by specialty drug manufacturers.

Applying Behavioral Coaching to Specialty Drug Adherence

Effective behavioral coaching ignites a two-way, patient-led conversation to identify and overcome barriers to specialty medication adherence, express empathy and offer personal support which results in a collaborative action plan to maximize adherence.

Patients taking specialty medications for chronic conditions face greater general adherence barriers, as well as some barriers unique to the specific condition.

For example, sensitive conditions like HIV and hepatitis C have social implications that may require more empathetic messaging during behavior coaching sessions than more socially acceptable conditions like diabetes or hypertension. Patients with visible dermatological conditions like psoriasis or onychomycosis often face quality of life issues that physicians may not fully conceptualize and may also require a higher level of emotional support.

Effective behavioral coaching conversations are driven by the patient

The help needed to overcome barriers to specialty drug adherence is individualistic in nature and takes investment, patience and experience. Effective behavioral conversations:

  • Identify a patient’s position on their specialty medication treatment regimen
  • Help patients clearly define their specialty medication treatment goals
  • Create a path to reach treatment goals with adherence support provided at each step

Alignment of goals between the coach and the patient is one of the most important steps in improving specialty drug adherence. The goals must have meaningful connection to the patient’s life. Patients are more likely to succeed if goals have personal meaning, as opposed to focusing on achieving an external reward or avoiding punishment.

A patient’s active engagement is the key to setting goals designed to help them commit to taking their specialty medications consistently. Coaches can engage patients by asking them three questions:

  • What do they think the next steps should be?
  • What are they committed to?
  • How you can support them?
The need for behavioral coaching for specialty drug patients is increasing

With the dosage complexity and costs associated with specialty and biosimilar medications, pharmacies and call centers offer varying levels of patient support. When building a comprehensive patient support program, it is critical for manufacturers to understand how the pharmacies’ approach to patient support complements their distribution model and patient experience goals.

In oncology, the use of behavioral coaching is growing significantly to support patients moving from an end-of-life diagnosis to them living with a chronic disease. The unique characteristics of cancer patients present complex challenges that impact the best approach to help patients achieve positive outcomes with emerging, specialty pharmacy treatments.

For instance, the use of oral oncolytics is rapidly expanding, offering patients promising new treatment options. Avoidance of intravenous therapy is one patient preference that factors into increased use of oral oncolytics. Convenience is another, as most oral oncolytics result in fewer physician office visits and less time spent receiving treatment compared to IV chemotherapy.

But the shift from physician office to a patient’s home also reduces professional oversight. This limits visibility into whether patients are taking their medication and if they’re taking it properly. Issues not only arise if patients don’t take the pills, but also arise if they take the wrong dosage or at the wrong times. Despite the fact that a cancer patient’s survival may depend on consistent adherence, research indicates that primary non-adherence rates within oral oncolytics can be upwards of 20 percent.

While some barriers to adherence with oral oncolytics are consistent with any therapeutic class, there are some that are unique to oncology patients. These adherence issues can be:

  • Patient-related: Medication concerns, understanding the importance of being adherent, feeling that healthy outcomes are unattainable
  • Treatment-related: Side effects, drug interactions, pill fatigue
  • System-related: Perceived support from oncologist, medication changes, financial burden

Over the course of treatment, many cancer patients will transition back and forth between acute and chronic symptoms and treatment plans. Barriers to specialty drug adherence will change over time. It’s important to set appropriate treatment expectations, recognizing that patients will need individualized support based on where they are along their journey.

Behavioral coaching conversations that leverage powerful tools such as active listening, open ended questions and reflective response have consistently increased adherence. The art comes in applying these techniques to complex and costly specialty medications.

Related: Learn more about McKesson Specialty Health’s behavioral coaching programs for medication adherence
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