Efficacy Expectations and Adherence: Evidence of Consumer Biases and Heuristics in Pharmaceutical Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 311

11.1 Introduction

Given the growing importance of health and well-being in consumers' lives,
pharmaceutical companies are held to particularly high standards of performance—
even higher than those in other industries (Turett 2005 ). Such expectations, though
justifi ably high, make customer acquisition and retention—two paramount goals of
marketing strategists—especially challenging. This challenge is perhaps most obvi-
ous in the compelling evidence in both the United States and around the world that
patients are not taking their medicines as prescribed. In fact, lack of medication
adherence is called “America's other drug problem” (National Council on Patient
Information and Education 2007 ) as it leads to signifi cant and at times unnecessary
health problems. The World Health Organization (WHO) estimates that globally
only about 50 % of patients take their medicines as prescribed, and in the United
States the annual cost of poor adherence has been estimated to be approximately
$177 billion. Therefore, it is crucial for pharmaceutical companies to fi rst under-
stand the factors that lead to poor adherence and then devise strategies to alleviate
this problem.
We defi ne adherence in the current context as conformity to, or adoption of,
marketers' recommendation about medication acquisition (purchase) and correct
usage (Bowman et al. 2004 ). It is important to note that we use the word adherence
to stress the importance of consumers' relationship with marketers. We borrow from
the medical pharmacology literature in distinguishing the subtle meanings between
patient adherence and patient compliance. The original concept of compliance
connotes a one-way relationship whereby the provider chooses the therapy and
specifi es, directs, or exhorts the patient to proceed as directed (Tilson 2004 ).
Decades of clinical pharmacy practice have given way to a new social contract of
patient adherence, which acknowledges that the patient is a partner in the decision-
making process. Similarly, we adopt the term “consumer adherence” in recognition
that the consumer is active in the search and evaluation of pharmaceutical remedies,
and a primary decision maker in their purchase and consumption. For these purposes,
adherence can be thought of as a process whereby consumers accept infl uence in
the hopes of gaining specifi c rewards (e.g., health benefi ts) or avoiding specifi c
detrimental effects (e.g., suffering from an illness).
Many factors infl uence (non)adherence to medicines. These include medication-
related, patient-related, prescriber-related, pharmacy-related, and condition-related
factors (National Council on Patient Information and Education 2007 ; Briesacher
et al. 2008 ; see Fig. 11.1 ).
As such, poor adherence is not only related to patients failing to take their
medicines as directed, but also to a variety of factors related to social-, economic-,
medical-, and policy-related issues that contribute to the problem of non-adherence.
Figure 11.1 presents a selection of prevalent issues under each factor.
Although these issues are equally important in reducing medicinal non-adherence,
we focus exclusively on patient-related factors in this chapter. A survey commis-
sioned by the National Community Pharmacists Association (NCPA) found a major