How Proof of Use Boosts Patient and Commercial Outcomes

Tracking when a prescription ships or a refill is dispensed is straightforward. What happens after a patient brings a self-injectable medication home is a different matter. That gap between possession and administration is, according to Kieran Daly, cofounder and general manager of HealthBeacon, the missing link that undermines patient outcomes and complicates the payer relationships that specialty drugs depend on.

The pressure to close that gap is growing alongside the shift toward value-based care. Under value-based contracts, payers assume additional risk associated with covering drugs with uncertain real-world effectiveness, while manufacturers assume risk should a therapy fail to achieve agreed-upon outcomes. That structure puts strain on whether patients are actually taking their medication — a question that has historically gone unanswered. Research assembled by the NIH Adherence Network found that self-report measures consistently overestimate actual adherence behavior compared with objective assessment methods.¹

Speaking with Pharmaceutical Commerce at the Asembia AXS26 Summit in Las Vegas, Daly discussed how proof of use connects patient outcomes to commercial performance, why the home setting is where adherence programs most often fall short, and what real-world evidence of medication administration means for manufacturers navigating outcomes-based models.

PC: How Does Improved Adherence Support Directly Tie to Profitability in Specialty Pharma?

Daly: What HealthBeacon does and what adherence helps to deliver in general is outcomes on all fronts. And what I mean by that is positive outcomes for the patients, because I think if you don't have that positive outcome and positive experience as a patient, then none of the rest of the good stuff will happen, and it's a house of cards that will collapse, right? What we see in how we approach adherence is that obviously if patients are more on time and on track in taking their regimen, then that leads them to forming better habits and getting into a better kind of time series and so forth. And where that catches up and rolls into the SPs and manufacturers and pharmacies in general, is, the more you adhere to your schedule, the more likely you are to fulfill your Rx across that year. So, what we're seeing in the adherence world is an uplift, a measurable uplift of adherence leads to one, two, three extra script fills depending on the cadence of the medication.

Tracking Shipments and Refills Is Easy, but How can Companies Track and Support a Patient’s Adherence to a Medication for Better Health Outcomes?

I think the missing link in a lot of adherence tracking concerns is actually what's happening on the ground in the patient's home. Historically, there's been all sorts of plays around adherence where you're relying on the patients to tell you what's happening, or you're shooting out some SMS messages and so forth, and really nobody knows whether they land or don't. And it's kind of maybe they do, maybe they don't, but we'll never know, and you could certainly never measure that.

A lot of what we try to do is cover that last mile of what actually happens in the home. Because I think it's when the patient is on their own, they're taking their injection and they're trying to keep on top of their treatment, that's actually when you need the support and when you need to try and get a picture of what's happening on the ground, and I think that's the missing link in a lot of adherence programs or how people think about adherence in general. For us, what we've developed is a smart sharps bin, a connected device effectively that sits in the patient's home, an FDA Class 2 cleared medical device. What that does is track disposal of their syringe or auto-injector or their medical waste into the sharps bin and takes a timestamped photograph of that, then pings it up to the cloud so we can verify whether the patient is on time and on track with the right medication. I think it's that real-time passive tracking in the home has often been that final breadcrumb that's missing as people think about adherence.

Why Is Proof of Use Essential for Manufacturers as Outcomes-Based Models in Specialty Pharma Expand?

I think direction of travel in healthcare, in general. There's more focus on value, which is no bad thing of course, but a big component of value is, Rx's are being written and these are really transformative medicines that are around today, but I think payers and general stakeholders in the ecosystem are looking for, "Okay, we want to get this medication to the right folks that need it,” but then there's this overhanging question going, "Well, are they taking it?" or, “are they filling scripts?” Even if the scripts are filled and it's in the home, what happens then? Just because they have possession of the drug doesn't mean they're taking it. So I think from the perspective of either value-based outcomes or how people think about data, there's a huge link between payer and value and actually proving that the patient is taking that medication. Because if you're taking the medication and getting the outcomes, everyone is in a happy path. If you're not getting outcomes and you're taking the medication, then that's one story, and that would lead to a switch or something of that nature. But actually, what we find in a lot of cases is patients aren't getting the outcomes, and they're not getting those outcomes because they're not taking that medication. So, I think that idea of having a real world view of what's happening in the home helps you to get those patients back on track if they're off track, and that can then be linked back to value, and particularly the payers, in terms of proof that the patient is in fact trying their best and staying on their regimen.

Reference

1. Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. “Self-report measures of medication adherence behavior: recommendations on optimal use.” Translational Behavioral Medicine, vol. 5, no. 4, 2015, pp. 470-482. PubMed, https://pubmed.ncbi.nlm.nih.gov/26622919/. Accessed May 22, 2026.