1. The Intervention Program THE MISSING LINK IN BIOPHARMACEUTICAL SCIENCES TM

2. A basic principle “Help your doctor help you”

3. medAmigo intervention program medAmigo med=medicine, Amigo=Friend

4. medAmigo patient management model Patient Starts Screening vs. Algorithms & Interventions Plans Intervention Plan Selected Physician & Patient Feedback Monitoring & Data Collection Intervention Physician & Patient Feedback

5. Measurement-Guided Medication Management (MGMM) based intervention Successful techniques for improving compliance require two key elements: Realistic measurement –the objective, continuous electronic recording of day by day dosing times, which can be easily interpreted by most patients Scheduled appointments with feedback –continuing periodic review with the patient, by the prescribing physician, pharmacist, or nurse of the patient’s ongoing dosing history.

6. Illustrative results of a medAmigo intervention Before intervention Dosing Time Days on treatment After intervention Treatment of osteoporosis V= a missed dose, 0= Sunday; 1= Monday; 2= Tuesday; 3= Wednesday;…

7. MGMM tested successfully in Hypertension McKenney et al., 1992 J Clin Pharmacol No Intervention (N = 34) Mean compliance = 78% Intervention (N = 36) Mean compliance = 95% Difference = 17% 12 weeks data

8. MGMM tested successfully in Hypertension McKenney et al., 1992 J Clin Pharmacol

9. MGMM tested successfully in Serious Mental Illness Month 1Month 6 Intervention81 ± 22% N=31 76 ± 22% N=25 No Intervention68 ± 27% N=29 57 ± 30% N=20 Difference13%19% P-value0.0230.008 Cramer and Rosenheck, 1999 J of Nervous & Mental Diseases

10. Burnier et al., 2001 J of Hypertension MGMM tested successfully in Resistant Hypertension

11. MGMM tested successfully in Smoking Cessation * p<0.05 ** p<0.001 Week ** * * Dose compliance Schmitz et al., 2005, Journal of Behavioral Medicine No Intervention N = 46 Intervention N = 51 Difference of ± 30%

12. MGMM tested successfully in HIV N=26 experienced patients (>6 months on treatment) De Bruin et al., 2005 Aids Patient Care 2 months 3 months Intervention 82%93% Difference = 11%, p<0.05 Larger confirmatory trial is ongoing

13. MGMM tested successfully in Lipid Lowering ~86% ~71% Vrijens, et al., Pharmacoepidemiology and Drug Safety, 2006 P<0.01 Daily Percentage of adherers Days since inclusion % 050100150200250300 60 70 80 90 100 Intervention No Intervention Difference of 15%

14. Poor adherence/short persistence Decreased drug efficacy Increased care costs Early dropouts; lost sales Patients LOSE Payors LOSE Industry LOSES Breaking the downward spiral Decreased care costs Payors WIN Industry WINS Late dropouts; retained sales Timely detection, focused Intervention Robust adherence/long persistence Increased drug efficacy Patients WIN