For the more than six years that MobiHealthNews has been covering the world of mobile and digital health pharma has always been one group that seemed just ready to break in. While providers and even payors have publicly gotten their hands dirty experimenting with telemedicine, remote patient monitoring, and patient engagement apps, pharma has largely been moving in the shadows through investments, or dipping their toe in the water with small, autonomous innovation groups.
Not anymore. Whether it’s the mounting pressure of the coming outcomes-based payment structures, or just the slow train of pharma development catching up with the times, most of the experts, consultants, and stakeholders MobiHealthNews spoke with in recent weeks believe that pharma has finally reached a turning point, and we’ll begin seeing serious investments in digital health this year. In fact, a few have already happened, including two major pharma companies — Roche and Novartis — teaming up with Qualcomm Life to make use of Qualcomm’s telehealth 2net Hub in research projects.
“When we launched the business, December of 2011, some of the first folks that came through the door were pharma, and we spent a lot of time with them very early on,” Qualcomm Life SVP and General Manager Rick Valencia told MobiHealthNews. “But it was typically innovation teams, and teams without a real specific charter. ... So we’re not working so much anymore with the innovation teams. Now we’re working with commercial teams. We’re working with people who have a title that indicates they have an area of responsibility, they have budgets, and in several cases they have projects with very specific timelines that we’re helping them execute on.”
Eddie Chan, the head of search and evaluation at Sanofi, echoed Valencia’s take on the recent shift in pharma thinking on digital health.
“Pharma is emerging from a prolonged observational period with respect to mobile health," he said. "There has been tremendous learning as to the influence, impact and stickiness of smartphone-enabled healthcare, accompanied by a certain degree of healthy skepticism as to the degree that these capabilities will drive behavioral change with both patients and HCPs. I believe that industry has started to turn the corner, and we are now seeing a more deeply-rooted acknowledgment that mobile health has begun and will only continue to profoundly impact the delivery of care and a patient’s relationship with her physician.”
How do outcomes-based payment models affect pharma?
It’s true, we’re still a long ways away from every hospital in the country eschewing fee-for-service in favor of an outcomes-based repayment model. But the country has also moved quickly in that direction over the last few years. This was a theme that played over and over at the ePharma Summit in New York City last month.
“If you look at what the Affordable Care Act has done with CMS, it has allowed them to put themselves in a leadership position to drive our healthcare system toward value-based reimbursement,” Greg Barrett, the VP of marketing and access strategy at Daiichi Sankyo, said at the event. “If you think back a couple of years ago, CMS probably had 80 or 90 providers around the country participating in a collection of pilot programs scattered throughout the United States. If you look at those same numbers today, we are now approaching up to 10,000 separate providers participating in value-based reimbursement programs in dozens and dozens and dozens of programs. … This is the big gorilla in the room and we need to pay attention to it.”
For one thing, value-based reimbursement takes the form of Accountable Care Networks and Integrated Delivery Networks, which means more hierarchy in provider decision-making. As decisions about prescribing shift away from the doctor, who has been the primary target of pharma marketing for the past 20 years, to the C-level of integrated delivery networks (IDNs) and accountable care organizations (ACOs), pharma is going to have to dramatically change how it sells drugs.
“Decision-making is getting stripped out of the point of care,” Manhattan Research VP of Research Monique Levy said at the event. “Now we know that physicians tell us one in two of the scripts they write is not based on their clinical preference. This is a big deal. Fifty percent of everything you’re doing is more or less irrelevant.”
Paul Ivans, president and CEO of Evolutionary Road consulting, said that although pharma will gradually see less return from selling to doctors, selling to higher up decision means pharma needs to market their drugs based on efficacy and plain demonstrations of ROI.
“Clearly we have to focus on IDNs and ACOs and their broader goals,” he said “They care about outcomes, quality, and decreased system costs. They don’t really care that my pill costs $10 more than your pill. But if my pill, plus a beyond-the-pill program helps patients be healthier and maybe reduces hospital readmissions by a couple of percent, we all know those are $15,000 to $20,000-dollar hospitalizations. … It just changes the game.”
As hospitals take on risk, value-based reimbursement has a way of trickling down to some of the vendors who sell to them. Providers don't necessarily want every one of their partners structuring agreements that way, but all will need to consider how their value propositions make sense in the new context.
“Because it effects providers so dramatically, they’re going to want everyone to have skin in the game,” Valencia said. “So to the extent that pharma can come up with a drug that [enables them to say] patients who are compliant using this drug tend to end up in the hospital less days [and] the morbidity rate is lower, they’re going to need to commit to that statement. And if they can’t deliver on it, they’re not going to get paid.”
That’s the rationale between Daichii Sankyo’s decision to work with Partner’s Health Care on an expensive longterm remote-monitoring pilot for atrial fibrillation. And it’s leading many pharma companies to look hard at “beyond the pill” programs: apps and behavior change platforms that can be offered along with a drug, to help guarantee compliance. Anu Gupta, a consultant with Boston Consulting Group, pointed to a recent Accenture Survey which demonstrates the extent to which patients have begun to expect more from their pharma companies.
“Seventy-six percent of those patients felt that the pharma industry had a bigger role to play than just providing medicine,” Gupta said. “They wanted the industry to provide complementary information around the medicine, they wanted some other services, and they were willing to share some of their private information in return for value. The industry has had to grow up and realize that the market has changed, and if they continue to just think of themselves as suppliers of medicine, they will be sidelined and they will be a bit player in this entire transformation of the healthcare system.”
Beyond the pill, or just around it?
Even once a pharma company decides to provide beyond-the-pill services, there are different levels at which they can approach it. One level, sometimes referred to as “around the pill” means pharma companies are providing something like a branded app that just goes with their drug. Interventions like this are starting to fall out of favor at many pharma companies.
“So there’s a specific brand, a medicine that has recently been launched and it’s not been widely enough adopted and there’s this beyond-the-pill offering around this medicine,” said Gupta. “And frankly the offerings here are not that innovative because they’re not solving the patient’s problem or the healthcare system’s problem. They’re solving the problem of not enough medicines being sold.”
Barrett, from Daiichi Sankyo, agrees. His company spoke to ACO and IDN executives and found a strong preference for solutions that were targeted not at one specific medication, but at a whole disease; apps and devices that could be used with a Daiichi Sankyo drug or a competitor's.
“If you look at programs like this as simply a marketing tool to drive your brand, then you miss the point,” he said. “We need to look at these tools as an integrated approach with your brand to improve healthcare. It’s only when you make that shift in thinking that you realize the true benefit of initiatives like this.”
At a panel at CES, Valencia heard Corinne Savill, the head of business development and licensing at Novartis Pharma refer to this approach as “owning the disease” — meaning, creating solutions that are with a patient through their whole patient journey.
“It is really interesting when you hear it from the mouth of a senior executive at a pharmaceutical company, who says things like ‘We’re developing solutions now where we can actually own the disease.’” Valencia said. “And that’s something you’ve heard from disease management companies, but you’ve never heard that from the pharma companies”
Earlier this year Novo Nordisk’s senior director of diabetes marketing Jeremy Shepler described the patient journey approach as he sees it — and it’s going to require some very sophisticated user experience design.
“Patient journey is really the experience,” he said. “Understanding not the functional changes, but the emotional changes people face as they go through this journey. As we’ve thought about how we think about this journey and this experience, what the intersection points are to help them be more successful through that journey. Behavioral challenges. Knowledge, success they need to gain. Healthy eating, hearing, listening, understanding emotional barriers, helping people be successful.”
Medication Adherence and Clinical Trials
The two most obvious areas for focusing beyond-the-pill — or around-the-pill — innovations are medication adherence and clinical trials.
Medication adherence is one focus area where the rewards for pharmaceutical companies are self-evident: getting patients to actually take the drugs prescribed to them improves health outcomes, may save the healthcare system an estimated $290 billion per year, and it means pharma companies sell more drugs.
Scripps Health cardiologist and digital health evangelist Dr. Eric Topol thinks medication adherence is still largely a missed opportunity for pharma.
“Adherence is one of their biggest growth opportunities, because 50 percent of prescriptions aren’t adhered to,” Topol told MobiHealthNews. “Whether they’re never filled, or they’re simply not taken. … And the question is can digital technologies improve on that? So far there’s only minor studies to suggest they can. GlowCaps and a few early studies. They’re not big studies and [pharma] certainly hasn't demonstrated an Apple-scale willingness to digitize tools and digitize pill caps and the various techniques for actual tracking of each pill. These sort of studies need to be done because it could make a real difference.”
That said, there are a lot of efforts underway to address medication adherence, from Boehringer Ingelheim and others’ pilots with AdhereTech, to Novartis’ work with Proteus Digital Health, to Johnson and Johnson’s huge, unbranded Care4Today mobile platform.
Qualcomm’s Valencia said he’s spoken with pharma companies that are working on an around-the-pill health coaching solution to help with adherence.
“Think of a very high value drug where it’s taken exactly as prescribed, and if it’s not, it’s very expensive,” he said. “Insurance companies are going to care very much. If compliance is almost assured, they’re going to reimburse. In the future you’ll see drugs like that prescribed, and also the patient will get an app along the way that’s part of the prescription itself.”
Down the road, he added, these apps could become very smart and be integrated with some way to track adherence, so they could change their approach to patients based on patient behavior in an effort to improve adherence.
BCG’s Gupta actually believes the industry is focusing too hard on medication adherence, to the exclusion of more potentially game-changing efforts.
“The industry is mostly spending time on medication adherence today, because the business case is the easiest to define there,” he said. “If you can get patients to take their medication on time and drive adherence and compliance the business case solves itself. That’s where the industry’s spending time now. But I actually think the greatest impact we can probably have, from an industry perspective, is clinical trials in specialized medicine and patient engagement when it comes to chronic disease. There are drugs that have never made it past the FDA review, or have never made it past toxicology that can now actually be tested given how carefully we can monitor patients. There were tests that the FDA would want that you couldn’t do the full version of. And now you probably could do that, you could probably get approval now.”
Gupta thinks that digital monitoring technology could enable new whole categories of clinical trials, in disease states like Alzheimer’s where it’s currently very difficult to measure the progression of the disease in drug trials. And even beyond drug trials, we’ll start to see more trials like Sanofi’s VERRKO trial, where what’s being tested is not a drug but the device itself.
“I’m talking about clinical trials where an arm of the trial is going to be about the drug and an arm is going to be about the drug, the device and an algorithm,” Gupta said. “And the intent is to show that the drug plus the digital solution is more efficacious than the drug itself, and the competing drug. I think it’s that kind of success that will prove to the industry this is no longer a science experiment, this is something that can be a game changer.”
Valencia confirmed that the pharma companies Qualcomm is working with are looking ahead to that sort of trial as well.
Pharma and innovation
One thing that one hears over and over when talking to pharma experts is that pharma is slow-moving and risk-averse. And when it comes to digital health, pharma is jumping into a world where innovation rules the roost.
“Innovation is a very hard process for pharma,” Gupta said. “You’re talking about an industry used to making 20 year bets and putting billions of dollars behind these molecules, and doing endless market research. And now they’re jumping into an industry where the successful players are characterized by their ability to fail fast and people use terms like 'minimum viable product'. Pharma’s never had to understand the concept of minimum viable product. You wanted to create a molecule or a medicine that was perfect in every which way. It needed to have all the safety and efficacy features. For an industry like that to suddenly understand how to play in this space of digital health is really, really hard.”
This disconnect between the typical speed of pharma innovation and the speed of innovation in technology is what leads pharma companies to seek partners with roots in the tech world that can help keep an eye on the road ahead.
Sanofi’s Chan described it as a culture clash, and he thinks it could have repercussions beyond just encouraging more partnerships. As pharma companies try to develop digital health tools on platforms that rapidly become obsolete, they may just end up inventing a whole new way to test products, including drugs.
"This differential speed is a significant challenge to our existing tools for evaluating clinical and economic effectiveness," he said. "To what extent do they apply to digital health, given that the rate of innovation may be outpacing our ability to evaluate these technologies in controlled study environments? The question then becomes, does the pace of innovation effectively make real-world testing and real-world data the new normal?”
That question is unanswered, and one group that will have to weigh in is the FDA. Obviously drugs and therapies will still need to be tested in controlled conditions and cleared with the FDA before they’re sold. But once they’re out there, can they be iterated and developed continuously based on patient-generated data? It’s certainly possible.
Pharma and Digital Health: Where to next?
Everyone agrees that pharma digital health innovation is happening. But beyond that, there’s not a lot of consensus.
“There are no pharma companies of any size that are not experimenting with digital health, but where they are on the journey is very, very different,” Gupta said.
For one thing, as many point out, it’s still a constant challenge to convince the higher-ups at many pharma companies to invest in digital health, because the return on investment is still very ill-defined.
“Today, if you talk to clients about digital health, the inevitable question is, so where do you want me to ship the dollars away from?” Gupta said. “It’s a zero-sum game. If I do this, I have less reps to deploy. I have less money to spend on the agency.”
But Chan thinks most companies have reached the point that a certain basic product set is expected of pharma companies — something the Accenture study backs up.
“Broadly speaking, a compelling hypothesis is emerging that the minimum viable product going forward is no longer the pharmacological treatment in isolation – but rather a tightly integrated offer in which devices, software and services complement the underlying drug and enhance treatment effectiveness," he said. "This is a transformational shift in industry thinking.”
Gupta thinks a lot of pharma projects will fail on the way to the industry figuring out exactly what its role is in digital health.
“I actually think where we stand right now, very few of them will be successful,” he said. “I think there’s multiple reasons for that. I don’t think they have the capabilities to develop the apps, the sensors, the technology, and the algorithms that are required to be successful in this space. So I think there’s a huge gap, that some of them are starting to address, but in most cases, they really don’t have the fundamental skill set required to be successful.”
The successful companies will be the ones that not only build true, patient-journey focused, beyond-the-pill offerings, but devote significant resources to those offerings, Gupta said. Though he couldn’t disclose names, he described a client who fits that bill.
“For example, I have a client who most of their medicines are injectable medicines and they had decided that innovative delivery devices for their injectable medication is the way to go,” he said. “That is one of the areas where they’ve defined their innovation. They’ve set aside $100 million, they have created a group of people with the right capabilities — people who have done startups before, people who are engineers and technologists, scientists — and they have given them the freedom to get started away from the mothership. They’re geographically in different offices, with separate governance and separate procedures, but they have a really clearly focused mission. I think these are the companies that are best positioned to be successful.”
Valencia says more and more companies are thinking that way, and several are going to be announcing digital health divisions with big name new hires in the next year.
“They’re getting very serious about this,” he said. “It really comes down to creating that connection with the patient that they’ve never had before. They believe they can do it with digital technologies and they believe they can prove that they can improve outcomes and, therefore, compete in that marketplace. … In this case, if it’s about adherence and it’s about compliance to medications, and if they can accomplish that and as a result the patient gets better, the cost of the system goes down, then it’s sort of a win for everyone.”
Pharma News Round-up
Read on below for a roundup of the biggest pharma headlines from the last year in digital health.
Q2 2014 Pharma News
This quarter saw some limited moves from pharmaceutical companies, but some long-awaited regulatory clarity for pharma could pave the way for more action in the second half of 2014, and some studies illustrated the value digital health could have for pharma companies.
The big regulatory news was the publication of the FDA’s long awaited draft guidance on social media usage, addressing a lack of clarity industry analysts had previously said was one factor holding pharma back from interacting online with its customers.
Earlier in the quarter, a study conducted by Boston University, Boston Children’s Hospital, Harvard Medical School, and Georgetown University researchers concluded that even though pharma companies might not be tweeting much, drugs were certainly being discussed on Twitter. They found that, for 23 commonly used drugs, well over three times as many adverse drug reactions were reported on Twitter in a given time period than were reported to the FDA. Of course, the study also notes that the tweeted reports, referred to as “Proto AEs” (adverse events) weren’t necessarily as specific or useful as FDA adverse event reports.
The other pharma-related study that came out this quarter was a survey from Accenture about what consumers wanted from their pharmaceutical companies. In general, consumers still weren’t that interested in hearing from their pharma company via the internet. Accenture found that those surveyed still most want to receive medication information by mail and email — 66 percent wanted information from their pharma company in printed form and 69 wanted it via email. For pharmacists, 72 percent wanted printed information and 73 percent wanted email. But demand was still reasonably high for mobile and web outreach — for pharma company information, 48 percent wanted to be reached via websites, 44 percent via mobile devices, and 38 percent via social media. For information from pharmacists, 64 percent wanted website outreach and 38 percent wanted an app, but only 15 percent were interested in hearing from their pharmacist on social media.
The survey also asked patients about specific “beyond the pill” services from pharmaceutical companies — what they wanted to receive and what they were receiving. The biggest disconnect was rewards programs — 63 percent wanted them but only 10 percent were receiving. The second most wanted service was product information at 53 percent, although 48 percent of respondents received it. The second biggest disconnect was financial assistance, which 51 percent wanted and only 10 percent received.
With one exception, the demand for every service exceeded the supply. Only physician referrals were provided more often than desired — with only 28 percent wanting them and 42 percent receiving them. Other services Accenture asked about were measurement tracking and alert (35 percent wanted, 20 percent received), access to patient support forums (29 percent wanted, 16 percent received), and access to clinical trials (28 percent wanted, 7 percent received).
In terms of actual moves by pharma companies, the quarter saw Genentech, Opko, Johnson and Johnson, Novartis, and AstraZeneca making moves in the space, either through launches or new partnerships.
Genentech, a division of Roche, partnered with PatientsLikeMe in April. The company signed a five-year deal for access to all of the online community’s de-identified data, the most wide-reaching data access partnership PatientsLikeMe has entered into yet. The partnership will allow PatientsLikeMe to move more into oncology, an area of focus for Genentech, than they have been in the past. Genentech will have access to to PatientsLikeMe’s network “to enable cross-sectional research and broader discovery of patient insights,” according to the press release. The company will also be able to search the data set more effectively and start their own research projects on the platform. They will also be able to use PatientsLikeMe’s network to both inform patients about clinical trials and iterate clinical trial design with patient input.
Also in April, biopharmaceutical company Opko Health acquired Israeli smart inhaler company Inspiro Medical for a sum in “the low eight figures”, according to Opko’s Director of Strategic Investment Les Funtleyder. The company will be using Inspiro’s Inspiromatic technology to develop an app-connected inhaler that will be bundled with a forthcoming new drug for asthma, COPD, and cystic fibrosis. Funtleyder said the company is not opposed, in the future, to licensing the technology out to other pharmaceutical companies to use with their drugs as well.
Wellness & Prevention, a division of Johnson & Johnson that works with health plans on behavior change coaching, launched a mobile app called Track Your Health toward the end of May. The app is not available to the general public but rather through health plans to the 30 million covered lives that have access to Wellness & Prevention products. Track Your Health can incorporate data from a number of third party health trackers and sensors, allowing users to track and aggregate data, set goals, and visualize their weight, movement and nutrition progress in the form of charts. Additionally, it will send anonymized data back to the health plan that users belong to. If users don’t have connected devices, they can enter some information manually or use the iPhone 5s’s built-in M7 motion co-processor.
Prior to its Q3 partnership with Google, Novartis was active in the second quarter partnering with health tracking and analytics platform Tictrac to launch an awareness campaign, called The 7-Day Challenge to Live Like You, for multiple sclerosis (MS). The campaign prompts participants to track different aspects of their lifestyle including weight, activity, mood, and workload. This data is used to create visualizations of their day-to-day life. Participants can sync various platforms and devices with Tictrac’s platform including Fitbit, Jawbone UP, Withings, Gmail, Facebook, and Runkeeper. Tictrac also encourages users to visit a Novartis online resource, called Living Like You, which publishes stories and content from those who live with MS.
After the seven days, the challenge will send users an email with customized insights about their lives. Some of these insights could be that users burn more calories when they get a good night’s sleep or that their weight decreases when they are stressed. The program will not provide medical insights.
Finally, a little over a year after completing a pilot study, pharmaceutical company AstraZeneca and Exco InTouch launched a mobile-enabled program in the UK to help patients manage their chronic obstructive pulmonary disease (COPD). The program, called Me&MyCOPD, has three components — a portal in which patients can connect with providers, a server on which information is saved and messages are schedules, and an app that the patient can use. Patients can use the program to track their condition, add data from medical devices, manage clinic visits, and view information on how to deal with different lifestyle issues. AstraZeneca will use this data to better understand what patients need and to give them personal goals and management tools to better handle their condition. Because physicians will have real-time access to patients’ data, they will also be able to monitor the patient’s adherence to treatment regimens and reach out to the patient if their condition worsens.
Q3 2014 Pharma News
The third quarter was a big one for pharma news, but no one company dominated the headlines as much as Novartis.
Novartis continued to make news in the third quarter, most notably by signing a licensing agreement for Google’s much-hyped passive glucose-sensing contact lenses. Novartis’ division Alcon mentioned two future use cases for the smart lenses. Noninvasive glucose monitoring (via tears) for people with diabetes was one. That’s the use case about which Google met with the FDA last year. The other was for people with corrective vision needs.
“For people living with presbyopia who can no longer read without glasses, the ‘smart lens’ has the potential to provide accommodative vision correction to help restore the eye’s natural autofocus on near objects in the form of an accommodative contact lens or intraocular lens as part of the refractive cataract treatment,” Alcon said in a statement.
Additionally, at some point during the summer, Novartis added a page to its company website describing its broad technology vision and explicit interest in mobile health. The document highlights partnerships, especially with startups, as an interest area for Novartis. In the post, Novartis highlights tracking and monitoring of patients as one of the biggest opportunities in mobile health. They mention the now-discontinued VaxTrak app, for instance, as well as Podhaler Pro, an inhaler training app for cystic fibrosis patients.
Novartis currently has about 16 iPhone apps in the Apple App Store, most of which are patient or consumer-facing. The list includes two games, “Sickel Cell Iron Invaders” and “Marley’s World” which are designed to teach players about Sickle Cell disease and Multiple Sclerosis, respectively. Their list also includes MyNetManager and Clinical Trial Seek, two apps that launched last March.
Several other pharma companies made moves in the third quarter: Bayer, Belgium-based UCB, Eli Lilly, Johnson and Johnson subsidiary Janssen, Roche subsidiary Genentech, Sanofi, and Boehringer Ingelheim.
Bayer launched what MobiHealthNews believes is the first digital health accelerator run by a pharma company. Grants4Apps, which started last year as a crowdsourcing initiative, was releaunched as an accelerator at an event earlier this week.
The commitment on Bayer’s part is pretty significant: they’ll be offering 50,000 euro (about $65,000) to each of the five startups, and taking less than 10 percent equity in the companies, according to a report from VentureBeat. The accelerator will last three and a half months and companies will also get free office space at Bayer headquarters in Berlin and biweekly meetings with healthcare mentors. The program will end on December 1st with a demo day.
UCB partnered with Cambridge, Massachusetts-based MC10 in July. Although many of the details remain undisclosed, the companies have announced that UCB will use MC10′s BioStamp technology to pursue new therapies for neurological disorders. There will be short term and long term benefits from the partnership, according to MC10. In the short term, its researchers who will benefit from having more complete and robust data on trial participants. But down the road, pending FDA clearance, UCB could make the technology available bundled with a drug or therapy, giving patients and doctors access to the data from BioStamp.
Eli Lilly and Company, the Indianapolis-based pharmaceutical giant went mobile, with a new responsive-design version of its non-commercial website Lilly for Better Health. The website presents a wide range of health information to consumers. The front page presents topical information designed to appeal to a wide range of people — in the summer months, for instance, it might give information about how to pack your medications when traveling, or tips for protecting your skin against the sun. The website also contains a database of resources in the form of articles, videos, and interactive features like quizzes.
In September, Sanofi Diabetes, a division of Sanofi-Aventis, launched a new mobile game for iOS and Android phones in the United Kingdom. The game, called Mission T1D, is meant to be educational, to teach children as well as their parents, caregivers, and friends about Type 1 diabetes.
The Health 2.0 conference at the end of September was rife with pharma news from Genentech, Boehringer Ingelheim, and Jannsen Healthcare Innovation. Genentech’s Joling Mew talked about the work the company has done with various online patient communities like PatientsLikeMe, Crohnology, SmartPatients, Inspire, and MediGuard. By seeking input from these patients, Genentech was able to fix the design of some very challenging clinical trials.
Boehringer Ingelheim announced a partnership with Propeller Health at the event, wherein Propeller attached a sensor to Boehringer Ingelheim’s Respimat inhaler for asthma and COPD patients. And Janssen announced that its medication adherence tool Care4Today is introducing a provider-facing component, allowing doctors and other care providers to track their patients’ adherence via the app. Care4Today also added Spanish language support.
Q4 2014 Pharma News
The fourth quarter of 2014 had more news for pharmacies and pharma-adjacent technology companies than for pharma companies themselves, though it certainly had a little bit of each.
First off, a few studies and reports broke in this quarter. A report from Research2Guidance showed that pharmaceutical companies have a lot of apps in the market, and have been making apps for a long time, but their apps aren’t seeing downloads and usage on par with the apps from other industries. According to R2G, the top pharma companies have 65 apps in the Apple and Google Play app stores on average, compared to one to two apps from the average health app publisher. However, even the pharma companies with the most downloaded apps have only accrued 6.6 million downloads since 2008 and can boast less than 1 million active users.
And a report from McKinsey gave some pointers on pharma companies getting into digital health. The report stressed that factors like changing patient behavior and fast-paced government regulatory changes are pushing pharma companies in the direction of implementing digital solutions. In addition, the report said, it's increasingly important for pharma companies to collect real-world data to present to accountable care organizations, not just clinical trial data.
In terms of pharma company news for the quarter, GlaxoSmithKline and Daiichi Sankyo both launched high profile mobile health trials. In GSK's study, conducted at their Human Performance Laboratory, six healthy participants used Vital Connect’s HealthPatch MD and ActiGraph’s activity monitor to track their vital signs, electrocardiogram (ECG) data and activity levels. They uploaded this data into an app from Medidata, which in turn uploaded it into the lab’s clinical record. Patients were asked to go through their normal daily routines, and only checked in with the lab at the beginning and end of the trial.
In the Daiichi Sankyo deal, Daiichi Sankyo and Partners HealthCare announced in October they would work together to create a mobile app for atrial fibrillation patients taking oral anticoagulants from Daiichi Sankyo. The app will have the goal of improving medication adherence and compliance and improving patient-provider communication and feedback loops.
And Biogen made a high-profile hire, recruiting Naomi Fried from her high profile position as Chief Innovation Officer at Boston Children's Hospital. Fried’s work with Biogen will be similar to her work at Boston Children’s, leading new innovation efforts for the pharma giant. She’ll have a particular focus on certain diseases.
Several of the big retail pharmacies made news this quarter too. CVS Health announced plans to launch a Digital Innovation Lab in Boston. The new space will accommodate approximately 100 employees, according to CVS, and 90 percent of the employees for the lab will be new hires. And Rite Aid agreed to distribute GreatCall products in more than 4,000 Rite Aid pharmacies. In addition, as an extra facet to the partnership, the Touch3, GreatCall’s current smartphone model, will now come with the Rite Aid pharmacy app pre-loaded.
Q1 2015 Pharma News
This year kicked off with some big pharma-related announcements at CES from Novartis and Roche, which both partnered with Qualcomm Life on new digital health endeavors. News also trickled in from Sanofi and Novo Nordisk. And, on the retail pharmacy side, Walgreens made a lot of news this quarter, partnering left and right for its Healthy Rewards program.
Novartis selected Qualcomm Life as a partner for its global Trials of the Future program, in which Novartis is endeavoring to use more mobile technology in its clinical trials and to provide connectivity for future Novartis products. Novartis will use Qualcomm Life’s 2net platform and various connected devices to collect medical data directly from trial participants in their homes.
Similarly, Roche will use Qualcomm Life’s 2net platform to capture patient data from connected devices, starting with anti-coagulation meters. In addition to its pharmaceutical business, Roche’s Point of Care product suite includes back-end testing systems for anticoagulants, blood glucose, blood gas and electrolytes, and urinalysis. The Qualcomm partnership will initially focus on anti-coagulation meters but could expand into these other areas as well.
Later in the quarter, Roche, through its venture arm Roche Ventures, also contributed to a $4.8 million round for mySugr, an Austrian diabetes app company. MySugr offers a handful of apps, but its flagship is called Diabetes Logbook, which is designed for people with type 1 or type 2 diabetes and includes logging, graphing, analysis, “exciting challenges”, “smile-inducing feedback”, and Apple Health integration.
Novartis also teamed up with Qualcomm Life on an investment fund, which will leverage up to $100 million to invest in “technologies, products or services that ‘go beyond the pill’ to benefit physicians and patients”.
Biogen Idec also made news with a big research-centered digital health partnership: It announced that it would team up with Google X to use sensors, software, and data analysis tools to collect and analyze data from people who have MS. The companies aim to explore why MS progresses differently in each patient.
Over at Merck, former Chief Medical Officer and Innovation Officer Sachin Jain revealed that he's moved to CareMore, a subsidiary of Anthem, and an integrated care plan that combines a Medicare Advantage plan with 24 care centers around the country.
Meanwhile, M2i2, the innovation group at Merck Jain led, has been restructured into two separate groups, both led by individuals Jain recruited from the public sector. Dr. Aman Bhandari will lead Merck’s data partnerships while Dr. Thomas Tsang will serve as chief medical officer for Merck Healthcare Solutions and Services, which will house many of Merck’s digital health projects.
Later in the quarter, Sanofi backed a fully remote clinical trial in Europe. Scotland-based eClinicalHealth will run the trial, called the VERKKO trial. The study will test a smart, wireless glucometer from Mendor that coaches patients on checking their glucose after learning from previous readings and schedules. Mendor’s glucometer isn’t smartphone-connected; instead, it has embedded cellular-connectivity and uploads user data directly to the cloud. Investigators can see all the data from the users, and the trial will produce outcomes and compliance data for Mendor.
While Sanofi doesn’t have a drug or a device under investigation, it is providing a good deal of the funding because it’s interested in using eClinicalHealth’s online platform in its own clinical trials in the future. Called Clinpal, the technology supports fully online clinical trials from recruitment to data capture, and notably includes electronic informed consent.
A number of pharma companies talked about some of their digital efforts at the ePharma Summit in New York City at the end of February. Novo Nordisk talked up its Ask.Screen.Now and Cornerstones4Care diabetes education initiatives, which use celebrities and channels like YouTube to spread awareness about Type 2 diabetes. Partners HealthCare in Boston and Daichii Sankyo shared more about their new partnership for remote monitoring atrial fibrillation patients. And My Gi Health, a public-private partnership between several universities and Ironwood Pharmaceuticals, shared plans for expanding its patient engagement tools beyond the world of gastrointestinal health and into other conditions.
Finally, the FDA launched a new app, called DrugShortages, to help health care practitioners and pharmacists track current drug shortages, resolved shortages, and discontinuations of drug products.
Q1 Clinical Trial & Medication Adherence News
Even before Apple made its surprise announcement of Apple ResearchKit, a new open source platform for medical research and electronic informed consent, mobile clinical trials were at the center of a lot of news this quarter, over and above the VERKKO trial sponsored by Sanofi.
A study of 660 children, published in the Journal of the American Academy of Pediatrics, showed that adding educational health content to text reminders for influenza vaccines improves the effectiveness of those texts, when compared with written reminders and texts that do not offer extra health information. And arecent study from San Francisco-based mscripts and retail pharmacy Avella Specialty Pharmacy found that mscripts mobile pharmacy app helped Avella’s HIV patients to become more adherent to their medication. About 79 percent of those using the app achieved at least 90 percent adherence, while only 65 percent of the patients not using the app posted that rate.
The biggest newsmaker this quarter was Walgreens, which inked deals with Glow, PatientsLikeMe, Qualcomm Life, and even video game company Atari. Glow, maker of digital health tools for women, integrated Walgreens’ Prescription Refill API into its app so that Glow users can refill their birth control prescriptions directly from their Android or iOS app. Walgreens added data from PatientsLikeMe to its online health dashboard, giving patients a view of possible medication side effects sourced directly from other patients.
In the Qualcomm Life partnership, Walgreens customers will be able to use 2net to sync certain mobile health devices, including a wrist-worn blood pressure cuff, a traditional blood pressure cuff and a blood glucose meter, directly to their Balance Rewards account, earning points each time they check their vitals. And Atari partnered with Walgreens to offer Balance Rewards points to users who are tracking their steps through Atari's new fitness app.