Apps, Sand, Patients, and Pachyderms.

I recently joined a panel for a PAP conference, and I plugged the meeting online at LinkedIn. Here’s what I wrote:

THEM (Tech company with a digital patient platform): Then the patients download the app to do HIPAA!

ME: And if they don’t have a smartphone?

THEM: Everyone has a smartphone!

<Pause> We were talking about PAP enrollment. PAP patients meet specific eligibility criteria, typically insurance status and household income, to receive their medications at no charge. </Pause>

ME: Which patients are you trying to help? If they’re under 400% FPL, they might have a flip phone. For PAP, I wouldn’t rely on an app only. Can they authorize HIPAA via text? How are they consenting to program participation?

Or, are you thinking that commercially insured patients may have lost coverage due to COVID, and you want to send them a push alert to apply for PAP? PAP may not be the solution.

What is the Manufacturer doing for Access in their digital campaigns? What do they say about staying on therapy during COVID? If they already reach patients who have opted-in, would they even need an app?

Is there any way prescribers could refer patients to PAP directly via EMR?

Do the commercial SPs inform patients about PAP if they lose coverage? How?

I’m a conference panelist. So. Many. Questions. 😉

#patientaccessprograms #patientaccess #pap

That’s it. That’s what I posted. And whoah, Nelly, do folks have opinions about apps! The number of emails I receive about apps still surprises me.

But every time I look at a company’s beta version, I can’t help but ask, “What are you trying to solve? Is this a problem for patients and HCPs?”

I’m going to do something I rarely do. I’m drawing a line in the sand:

I don’t like apps for manufacturer patient support services.

There. I said it. (Funny: Grammarly just kicked up a “Want to sound more diplomatic?” suggestion bubble.) The only exception I can imagine is specific cell therapies where coordination between Manufacturer, prescriber, case manager, patient, hospital, health plan, and supply chain is so critical that an app with multiple account/user profiles makes sense.

So I’m drawing a line in the sand, but not in concrete.

What are you trying to solve?

  • Do you want patients to know that they may be able to use copay support to help with their out-of-pocket costs?
  • That they need to take their pre-filled auto-injector out of the fridge and let it sit at room temperature for 30-minutes before administering?
  • Would you like to remind them that staying on therapy and taking their medicine as prescribed is essential?

Then, digital, yes; apps, no. I think mobile web and SMS (especially SMS) are fantastic channels for manufacturers to reach patients. They are less expensive to build, they are faster to update, and they are just plain easier for patients. Apps make patients work. They require effort to download and can hog device memory. And if you have a manufacturer app for one drug, you have just that: a manufacturer app for one drug.

“But apps are encrypted, SMS and (some) mobile web are not!” you may say. “If you have an app, the patient can track their symptoms or enter calendar information about their doctor’s visits and then get reminders.”

Ok, sure, you’re right. But how much sensitive information do patients want to be sharing with drug manufacturers? And frankly, I believe that the risk to the Manufacturer in collecting that information far outweighs any potential patient data goldmine. I read “symptoms,” and I think reportable AEs (adverse events) and safety signals. I hear a patient-entered calendar, and my former life as a practice manager flashes before my eyes. Clinics reschedule doctor visits all the time. If the patient doesn’t update their calendar on your app, now you have a confused patient and an irritated doctor. Don’t do it. (And again, Grammarly asks me if I want to sound more diplomatic. Nope.)

Patients don’t trust Pharma manufacturers. 

They just don’t. They are grateful for life-changing medicines, but they don’t trust commercial pharma. Do you know whom they trust? Nurses. And then doctors. And then pharmacists. Advertising practitioners? Notsomuch. Patients want conversations, want connection with health care providers, not pharma companies.

Apps can be useful for pharmacies and healthcare systems. Patients on multiple medications can manage their entire therapy course, regardless of who makes the medicine on pharmacy and health system apps. The conversation securely (thanks to encryption, which SMS does not offer) stays between a patient and their care team. 

If your Brand’s marketing team is not looking at ALL the digital messages your patients receive, they should be.

  • What kind of emails and online events are patient advocacy groups hosting?
  • Do your prescriber offices send appointment reminders with a click on the EMR that triggers an app push alert to the patient? A text? An email? Have you read these reminders, do you know what they look like?
  • Does your prescriber’s staff email intake forms to the patient in advance of the visit? Do they ask the patients to bring it in with them? Email it? Log into a secure website and upload? Do they even use clipboards at the front desk anymore? Maybe. Maybe it depends on the prescriber specialty and patient disease area.

  • Can prescribers refer the patient to a manufacturer support program using the EMR when they write a prescription? Or do they need to snail-mail a hard copy Manufacturer enrollment form? Can they email a .pdf? What can a patient do with a .pdf? Is there any way that prescriber’s staff could just use DocuSign? Or click a button that sends something DocuSign-like?
  • Does the pharmacy text patients when their medication is due for a refill? What other exchanges do they have with patients? Are these messages part of normal pharmacy operations, or are they considered, contractually speaking, enhanced services? Can the manufacturer partner with the pharmacy on (MRL-approved) verbiage and digital patient messaging?

If your Brand isn’t talking to Channel and Patient colleagues about what platforms and systems their pharmacy and vendor partners use, then your Brand is missing out. Don’t assume that if you, Manufacturer, build it, they will come. Ask your Patient Support colleagues for the data. What percentage of copay patients who enrolled online did opt-in to marketing? Don’t think that if you build a sexy brand website, your patients will sign up for alerts on disease state education and medication reminders. Some patients may, but many won’t. See the elephant above.