english.prescrire.org > Positions > Corporate behaviour > Big Pharma's medication compliance programmes

Theme: Corporate behaviour

Pharmaceutical companies are in the business of making money. Shareholders demand it, and managers’ jobs depend upon it. Pharmaceutical companies are increasingly obsessed with the bottom line. Their behaviour all too often shows it. 

Big Pharma's medication compliance programmes

Just say No! For several years, pharmaceutical companies have been investing in new ways to retain their "customers", for example under the guise of programmes designed to help patients follow long-term treatment courses. It is time to put an end to this dangerous trend.

A major challenge for any company is to find ways to maintain customer loyalty (a). This applies to large drug companies too, as part of their intense efforts to trivialize drug use and commercialise medicines. They are well aware that it is far less expensive to keep an existing customer than to find a new one (6 times less costly according to some studies). The pharmaceutical industry estimates that 30 billion dollars in sales are lost each year (out of a total of 600 billion dollars in global sales), because patients interrupt their treatments (1).

Medication compliance programmes
To comply or not to comply For several years, pharmaceutical companies have been investing in new ways to retain their "customers", for example under the guise of programmes designed to help patients follow long-term treatment courses.

Treatment compliance, i.e. the notion that a patient follows to the letter a treatment prescribed by a doctor or recommended by a pharmacist, has its good and bad sides. A patient who stops treatment too soon may suffer ill effects. Sometimes, however, a patient has good reasons for stopping treatment, because of adverse effects, for example, or inefficacy. The decision to continue or to stop long-term treatment can be a difficult one, and should be discussed by the patient and a healthcare professional.

Pharmaceutical companies' intrusion into patient "coaching" started in the United States, where drugs are more heavily commercialised than in Europe. Pharmaceutical companies set their own prices in the United States, and can promote prescription-only drugs directly to the public. "Medication compliance programmes", which are simply a sophisticated form of advertising, are flourishing. Such programmes are starting to enter France by the back door.

Unacceptable draft law in France French parliamentarians are soon going to vote on draft legislation aimed at adapting French law on medicines to EC rules. Article 29-10 will, if adopted, authorise the French government to legalise "support programmes for patients on drug treatment, provided by pharmaceutical companies". This provision, which is not mentioned in EC rules, is to be forced through Parliament, with no opportunity for debate. Yet such programmes boil down to direct-to-consumer advertising of prescription drugs, which is banned in Europe (2-4). The draft text states that companies will be able to launch "individually tailored measures (telephone reminders, free phone numbers, personalised patient education, home nurse visits, etc.)" (5). If allowed to pass, this provision would allow BigPharma to envelop all aspects of healthcare provision, with its major involvement in initial and continuous education of healthcare professionals; its strong involvement in patient "information"; its strong influence on marketing authorisation procedures for new drugs; and, soon, Big Brotherlike controls aimed at ensuring that we have correctly taken all our pills, and met our consumption targets…

Stop industry interference It is time to put an end to this dangerous trend. One major conclusion of a recent French Senate report on medicines is that conflicts of interest are widespread and that the roles of the different players in the medicopharmaceutical field are becoming increasingly confused (6). These "medicine compliance programmes" could only worsen this confusion: how could anyone imagine that a pharmaceutical company, in the position of both judge and jury, would willingly explain to a patient that he or she had better stop taking one of its drugs, or switch to a competitor’s product?

©Prescrire 2007

Prescrire Int 2007; 16 (87): 32.

a- A similar article was published by the French daily newspaper Le Monde on 28 September 2006, under the title "Big pharma nous surveille" ("BigPharma is watching us").

1- "Patient compliance is a 30 billion complaint". Website http://www.bioportfolio.com accessed 25 September 2006: 4 pages
2- Prescrire Rédaction "Alerte citoyenne" Rev Prescrire 2006; 26 (271): 241.
3- Prescrire Editorial Staff "Transposition of Directive 2004/27/EC on human medicines: beware" Prescrire Int 2006; 15 (83): 115.
4- Prescrire Rédaction "Programme des firmes pharmaceutiques d'"aide à l’observance": l'mposture" Rev Prescrire 2006; 26 (271): 300.
5- "Ordonnance: rapport au Président de la République". Website http://www.prescrire.org accessed 25 September 2006: 9 pages.
6- Hermange MT and Payet AM "Rapport d’information fait au nom de la commission des affaires sociales sur les conditions de mise sur le marché et de suivi des médicaments" Sénat 2006: 105 pages.