Should pharma make use of this opportunity and invest in patient engagement to build brand recognition with users of its products? We would argue so. The days of uni-directional doctor-to-patient communications are long gone, and a safe and effective product will only get you so far.

Patients have become important influencers regarding prescription decisions – not only for themselves but also for other patients. Without patients being confident and vocal about a product, doctors will be less inclined to prescribe it.

This effect becomes even stronger when patients also share their positive experience with friends and family members living with the same condition: requests for specific medications have been shown to dramatically affect prescriptions.

But why not let a product’s evidence speak for itself? We found that patients’ confidence and propensity to promote can differ significantly, even among very comparable products such as NOACs.

Over three days in spring 2019, we ran a short, ten-question questionnaire (Patients’ attitudes towards NOACs) for nearly 850 anticoagulation patients using MyTherapy, our medication and disease management app.

The results, as depicted in the chart, suggest that patients are equally likely to promote Xarelto and Eliquis, despite the latter earning more confidence. More notably, Lixiana users are far less likely to promote the drug than Xarelto or Pradaxa users, despite having a similar level of confidence in the drug as Xarelto users and significantly more confidence than Pradaxa users.

Are Lixiana users missing the confidence that Xarelto and Eliquis users have, and is this what influences their propensity to promote the drugs? Patient engagement and brand perception may not be the only answer to that question but, in the digital era, it is not far- fetched to believe it plays a role.

The results also suggest that even the drugs that are performing well have room for improvement regarding patients’ understanding of their treatment and value of the drug. Patient engagement can help improve these aspects, further enhancing a brand’s recognition in the eyes of patients.

3. Digital medicines (DTx): can you afford to stay out?

In most developed markets, healthcare spending, measured as a percentage of GDP, has reached a plateau. There is reason to believe that within this pie, the spending on medicine is similarly stable. Once reimbursed, digital medicines may well start eating into this spending, effectively shrinking the market for pharma’s traditional products.

Of course, there are a lot of ‘ifs’ and assumptions involved, but can pharma afford to wait and see? Companies like Novartis have started to embrace digital medicines as part of the core business. Looking at recent developments, we believe that they have been well advised.

a) Digital medicines are increasing in number and scope; they can be supplementary to pharmaceuticals or even replacements for them. Prime examples of cognitive behavioural therapy programmes for substance and opioid use disorder are reSET and reSET-O.

Welldoc says its BlueStar digital assistant for people with type 2 diabetes is clinically proven to reduce the need for medications and supplies. A range of digital medicines is being developed for mental illnesses.

For cardiovascular diseases, researchers claim changing patient behaviour would have more of an impact than any traditional medication currently in development. Over the last years, a considerable digital medicines pipeline has emerged, and the list is only going to get longer.

b) Reimbursement models are evolving. Until recently, reimbursement was rather indirect, for example, by using digital medicines for safeguarding pay-for-performance deals and value-based reimbursement models.

The next step is direct reimbursement of digital medicines, and Germany is leading the pack. Its recent Digital Care Act (Digitale- Versorgung-Gesetz) will become effective as of January 2020 and make technology such as apps prescribable if they have evidence for efficacy and live up to standards in privacy and data security.

Effectively, the German assessment and reimbursement mechanism for digital medicines will not be too dissimilar to the way it assesses and reimburses non- digital medicines. Other countries will surely follow suit.

c) Digital medicines require a new set of capabilities that go far beyond digital product development and can hardly be built overnight. For any digital product, achieving effective engagement and retention requires many iterations with actual users – just look at online gaming and how much it has evolved over the years.

For an industry that is infamous for talking a lot about patients but not so much to patients, establishing and acting on this feedback loop is a whole new challenge.

On the whole, it looks as though digital medicines are moving ever closer to pharma’s core business. Waiting on the sidelines to see if and when digital medicines will really go mainstream is one strategy. Another strategy is to start building the capabilities and embracing the opportunity before the head start that digital medicines have makes them impossible to catch.

The business case: good for today, essential for tomorrow

Historically, significant engagement has not existed between patients and the pharmaceutical industry, between whom there has always existed a large level of detachment. Technology allows this gap to be bridged.

The bridge is gradually being built by large tech firms, start-ups and policymakers. Pharma companies that embrace its construction can make it an immediate business case, be it through adherence/ persistence, brand recognition, or both.

However, most importantly, they have the chance to use this bridge to deliver a future core of their business: digital medicines.