What are the key questions that drug delivery
developers should ask when developing drugs for
folks treating chronic diseases or illnesses?
The first question a company should be asking themselves is “How can this drug or delivery method fit into the patient’s life in a way that requires the least amount of additional accommodations and mental gymnastics possible?” I don’t want to have to do mental gymnastics to think about when I last took my medication, maintaining adherence with a multiple times a day dosing schedule, or if I have to travel with an ice pack to make sure my medication stays at an optimal temperature when I am headed out on vacation.
The next question a company should ask is, “How can I reduce intimidation factors?” We know for a lot of patients living with chronic illness, there is the fear of self-injecting or the fear of managing your own medication. How can you reduce some of those intimidation factors?
And finally, how can you ensure that the patient does not feel isolated in their treatment experience? This could be through a nurse navigator, educational guides, programs that connect you to peers, etc. When you’re living with a chronic condition, it can feel isolating. Taking on a medication regimen that is, in some cases, life or death or the difference between being able to get out of bed or not, requires support.
"How can you ensure that the patient does not feel isolated in their treatment experience?"
Is there a part of the patient’s drug administration journey that you think is under-examined by drug delivery and development?
Something that I’ve noticed more recently, especially in the work that I’ve been doing with patients who self-inject, is how to mitigate moments of panic. When you’re going through self-injection, there’s an overwhelming number of things that could go wrong. Just personally, once my medication was delivered to the restaurant next door, and I had to track it down via Twitter. Once when administering my medication via an auto-injector, I didn’t push down hard enough and the very expensive medication pooled on my leg. So what do you do in a moment like that?
My recommendation to companies would be to bring in a panel of patients and get their feedback and experiences on drug delivery, whether it’s oral administration, self-injection, infusions, etc. They could take that feedback and give patients a place – a portal, an app, a pamphlet, or a number to call – to go and mitigate these moments of panic. These medications are often very expensive and very difficult to get. What do you do when something goes awry?
You’ve done research into self-injection rituals that patients go through as they administer their medication. What did you learn?
There’s definitely a number of trends. One frequent point is forgetfulness about, for example, switching injection sites to give medication. I have to switch sides every time I self-inject and I honestly often struggle to remember which side I injected last. Many patients create rituals around their injections to combat fear, such as letting the medication rise to room temperature to help reduce sensation and pain, or practicing self-care and setting out a dessert for after self-injection.
"Get patient feedback and experiences on drug delivery, whether it’s oral administration, self-injection, infusions, etc., to go and mitigate these moments of panic."
Do you think there is room for improvement for pharma companies to better assist patients through self-injections?
I would encourage pharma companies to work on helping patients remember when to inject, what side to inject, and provide a better vessel for disposing of your medication in a sharps bin, to improve the medication management experience for patients and caregivers. Beyond that, it’s amazing when a nurse navigator option is available, whether through a home visit or a virtual one, to help train a patient, help them feel comfortable and to check in with them. Finally, educational material, such as video tutorials or real patient stories can be very valuable.
Are there other issues that arise for you that haven’t been mentioned yet?
There are extremely concerning issues with insurance and access to medication. Through practices like step therapy and non-medical switching, patients are being switched or taken off of their physician-prescribed medications. Thinking back to my comment about mitigating moments of panic, this is a big one. Are there guidelines or resources that a pharmaceutical or drug delivery company can point to or provide to help patients navigate these devastating access roadblocks?
What’s encouraging is that there are a number of pharma companies that are in fact working to help provide resources, but many patients are unaware the programs exist. For example, some companies have introduced stop-gap programs to help you access medication if your insurer pulls the rug out from under you and denies coverage. These programs can be life-saving. By working with patient advocacy organizations and patient advocates, pharma companies can help elevate these resources and programs to ensure the patients that need them most can access them.
