Melissa Leonhauser, SDI

Studying patients’ prescription behavior over time is nothing new; the industry has been utilizing longitudinal patient data for over a decade. But what is new is tracking and combining information about patient behavior beyond prescriptions for a more comprehensive view of patient care. 

More recent data additions, including medical and hospital claims, lab tests and consumer attributes, improved the understanding of market dynamics and likely influences of patient and practitioner behavior. But this expanded view was still limited, especially in markets where prescription drugs compete with, or are complemented by, over-the-counter (OTC) drugs and consumer packaged goods (CPG). 

Today, studies can include another component of patient behavior: which what OTC drugs and other goods they are purchasing. This additional insight has expanded the view into how patients—and in some cases their caregivers&mdash;are managing their health. 

	A major advantage of including patient OTC and CPG purchasing information is that it more accurately identifies when a patient enters a market and how much time elapses from that point until they fill their first prescription. Historically, patients were considered to have entered a market when they visited a physician for an associated condition or when they filled a prescription for a market drug for the first time. 

But this isn’t truly accurate for markets where OTC drugs and other goods play a role. For instance, acne sufferers can be considered to have entered the market when they initially try to treat the condition by purchasing OTC products. And patients with overactive bladder enter the market when they begin purchasing absorbent undergarments—which can be long before they visit their doctor for the first time. 

Once patients are considered to be part of the market, their purchases and physician visits can be monitored to determine just how long it takes for them to receive and fill their first prescription, if they ever do. In some cases, this takes a long time because patients are able to adequately treat their condition or its symptoms by altering their lifestyle through, for example, dieting or use of OTC therapies. In other markets, the time that elapses is quite short as symptoms are too severe and OTC medications aren’t strong enough to provide substantial benefit. The price of OTC options also plays a role, either expanding or shortening the amount of time a patient remains on therapy before moving on to a prescription. 

	To understand market dynamics, manufacturers are often interested in identifying the most common paths patients take from first-line therapy through subsequent lines, and which product combinations and regimens are used. With insight into OTC drug purchases, better understanding of paths of therapy is possible. In some markets, such as allergy, prescription brands have to compete with equally effective OTC options of similar strength. It is even more common in these markets for patients to use OTC medications before, during, and/or after receiving prescription drugs, which therefore makes understanding typical paths of therapy even more important. 

In addition, knowing how patients travel from therapy to therapy gives insight into practitioners’ treatment tendencies. Even though patients are always de-identified, practitioners are not. Therefore, patient purchasing behavior after an office visit with their physician can be studied. Physicians with a tendency to recommend OTC drugs or other retail goods can be identified based on the subsequent behavior of their patients. The same is true of physicians whose patients are less likely to try an OTC alternative. 

	Since improving therapy adherence is a major objective for a variety of players in the healthcare industry, including manufacturers, payers, pharmacies, and physicians, understanding what a patient does during lapses in prescription therapy is critical.

	In the past, when patients stopped filling prescriptions on time, it was assumed that they stopped therapy altogether. But recent studies that include information about patient OTC drug and other purchases show that this isn’t always the case. Because of cost or convenience, patients are sometimes replacing their prescription drugs with OTC alternatives, making them look noncompliant. If manufacturers or pharmacies then reach out to these patients with education about the importance of remaining on therapy, their efforts would most likely be ineffective because these patients aren’t noncompliant—they’re just continuing on a different therapy than prescribed. 

Understanding what brands and strengths of OTC drugs patients are replacing their prescription therapy with is important to manufacturers. Depending on the findings, manufacturers may be able to address the cause of the switching and potentially maintain a greater percentage of patients. 

	An interesting insight that can be gleaned from the combination of healthcare and purchasing behavior data is what brands and products are being purchased in conjunction with a prescription or by patients in a therapeutic market. Applications of this data can be wide, as different stakeholders could use it for varying objectives. 

Drug manufacturers, who have limited ways of reaching patients who have not joined loyalty programs, may want to partner with the CPG manufacturers whose products are frequently purchased by patients in their market. One way to do this would be to tap into the CPG manufacturers’ outreach programs. Retail stores and pharmacies are also interested in this information to help inform programs aimed at increasing front-of-the-store or back-of-the-store sales, or for merchandising and purchasing planning. 

	The crucial technology that allows purchasing data to be combined with other sources to track patient behavior over time and across sites is the creation of the patient key. This process takes patient information such as name and birth date and replaces it with a stream of characters. The patient key removes all personal identifiable information and becomes an anonymous identifier. 

There are a number of requirements for creating a successful patient key methodology. First, the patient key must be irreversible so that no individual working with de-identified patient data can determine patient identity. This is extremely important to protect patient privacy and to comply with HIPAA. Second, and vital to the accuracy of any study, the patient key methodology must be intricate enough so that whenever an individual appears in the data, regardless of the source, he or she is assigned the same patient key.

Otherwise, if multiple individuals are assigned the same patient key, or one individual is given multiple patient keys, a patient’s history and future actions will not be tracked accurately. 

Information about individual patients is readily available from sources such as prescriptions, medical insurance claims, or electronic medical records. These inputs make it relatively easy to create the patient keys. Sources of CPG purchasing data, however, aren’t as straightforward because they can be tied to more than one individual. 

Purchasing data is collected when a shopper uses a store loyalty card program. When issuing the loyalty card, the retailer collects information about the consumer requesting the card, but often that card is shared with other members of the household. For example, it is likely that, in most cases, a husband and wife utilize the same card for the same store. Because this information is collected at a household level, an additional step to determine the individuals present in a household is needed to link activity to individual patient keys. 

Certain organizations collect and aggregate loyalty card purchases across retailers. Utilizing their information allows for a broad view of what is being bought by different households, although limitations do exist. The biggest challenge is that researchers are reliant on the consumer to use loyalty cards. Each retailer’s success in card utilization varies, depending on consumer benefits and if purchases can be applied if the consumer does not have their card on hand. 

Whether the goal is to identify when patients truly enter a market, to understand typical paths of therapy, or to help them be more compliant on prescribed therapy, incorporating information about their OTC and consumer goods purchases can provide insight to make strategies more effective. PC 

) is a Director of Strategic Marketing for SDI. She maintains expertise in secondary market research sources and studies and has extensive experience working for both manufacturers and data-providers. Melissa specializes in using empirical data to help marketers and market researchers improve their practices. 

Articles

Combining prescription and OTC purchasing patterns gives deeper insights into patient behavior