The Gamification

Playbook for
Pharmaceutical
Marketers

Tom Kottler Gabe Zichermann

Co-founder and CEO, HealthPrize CEO, Onward
Table of Contents
1 Introduction
3 Origins of Gamification
5 Exploring the Science of Gamification
7 What Every Game Designer Knows
13 Desire, Dopamine, and Gamification
16 Misconceptions and Pitfalls on the Way
to Meaningful Gamification Experiences
18 Gamification Success Stories
19 Reducing Unsafe Driving Behavior
in Sweden
20 Using Gamification to Reduce Energy Usage
21 M
 otivating Patients to Engage with
Diabetes Education and Fill Prescriptions
22 H
 ow Pharmaceutical Marketers Can
Improve Adherence with Gamification
24 H
 ow HealthPrize Mastered Gamification
to Improve Medication Adherence by 52%
27 E xtrinsic vs. Intrinsic Motivation
29 C
 onnecting Health and Healthy Behavior
30 G
 lossary of Terms
31 R
 eferences
Introduction
When you log in to your LinkedIn account after being notified that
someone has looked at your profile, or when you check your
Facebook feed multiple times a day to see what new updates
your friends have posted, or when you instantly rate an Uber
driver, your behavior has been affected by gamification.
Today, gamification, the practice of incorporating game-
like elements into non-game settings, can be found
everywhere consumers are, whether in a brick-and-mortar
storefront or on a brand’s social media profile. And it’s
not just for consumer goods and apps. Gamification can
be used to attract and retain customers in any industry,
including the pharmaceutical industry.
By using core tactics of gamification in its digital engagement
programs, pharmaceutical marketers and brand managers can
tap into the psychological aspects of game mechanics to create high-value

1 Gamification Playbook
interactions with patients. Gamification can encourage and reinforce improved
habits and behaviors such as taking one’s medication as prescribed or refilling
prescriptions on time.
As we’ll explore throughout this playbook, gamification applied more broadly
can be a vital key to addressing the problem of non-adherence, the issue that
cost the pharmaceutical industry $637 billion in 2015 alone.1
This playbook will cover multiple aspects of gamification and how they apply
to pharmaceutical marketing, including:

• Basic facts and definitions

• The science behind why gamification works
• 10 game mechanics that we can apply to patient behavior
• 3 gamification success stories
• A look at how HealthPrize incorporates gamification into our platform

2
Origins of Gamification
To be clear, gamification and games are not synonymous. The practice
of gamification involves extracting the elements of gameplay that people
find compelling and using them to drive actions and behaviors outside of
a game context.
If we can isolate the active ingredients that make games addictive, we can
incorporate those ingredients into digital technologies to help drive healthier
behavior. “For instance,” says digital behavior scientist Brian Cugelman ,PhD,2
“We can make a routine non-game activity, such as taking medication, into
a game that is fun and engaging by adding game elements, such as earning
points for taking medications.”

3
While game elements can be added to nearly anything, it’s only in the
21st century that its applications have expanded beyond basic consumer
marketing efforts. Thomas Malone’s work, “What Makes Things Fun: A Study
of Intrinsically Motivating Computer Games”3 was released in 1980 and
sparked the first frequent flyer program (American Airlines, 1981), the first
hotel loyalty program (Holiday Inn, 1983), and the first car rental rewards
program (National Car Rental, 1987).
In 2002, the Serious Gaming Initiative was formed to promote the use of games
for serious purposes, establishing clear links between electronic games and
public policy, health, education, and training. As gamification software provider
Bunchball, puts it:
“People have fundamental desires for reward, status, achievement, self-
expression, competition, and altruism, among others. These desires are
universal, and cross generations, demographics, cultures, and genders.
Game designers have known for years how to address these needs within
gaming environments, and gamification now enables these precepts to be
applied more broadly.”4

4 Gamification Playbook
Exploring the Science
of Gamification
Not only can gamification be applied broadly,
it’s remarkably effective when done correctly. A
2014 literature review by Hamari et al. concluded
that gamification provides positive outcomes,
though it stressed the importance of context.
Gameplay elements alone don’t automatically
deliver results; they must be incorporated
carefully into an initiative from its inception.5
Game designers have mastered the art of
providing the perfect mix of challenge and
reward. They rely on game mechanics, a
set of basic actions, processes, and control
Juho Hamari, PhD
mechanisms that make gameplay challenging, Professor of Gamification
rewarding, fun, and satisfying. Tampere University of Technology, Finland

5
Game mechanics are at the core of how
designers create an experience that
hooks users into a digital experience.
These very same mechanics can help
marketers draw customers in, keep
them engaged, and motivate them to
take their medications as prescribed.
As this playbook’s co-author
Gabe Zichermann has said before,
“Gamification can make the process
of adherence more fun and enjoyable
because even in the landscape
of multiple things competing for
people’s attention, we can use
gamification to make taking your
medicine more pleasurable.”

6 Gamification Playbook
What Every Game Designer Knows
The Ten Core Game Mechanics
There are ten fundamental game mechanics, but they don’t necessarily all have
to be used together in order to be effective. Instead, think about what you want
your “player customers” to feel and what behaviors you want to encourage or
teach when choosing which mechanics to employ.
1. Onboarding
The best video games teach you how to play the moment you pick up the
controller. By starting off with simple tasks like exploring your application or
logging their vital statistics for the first time, gamification eases your player
customers into the process, building confidence and satisfaction with
every achievement.

7
2. Goals
Clear, concrete goals keep player customers on track, focusing them on the end
result and motivating them to get there. Many games are guided by one main
goal, but each step along the way is another, smaller goal. These micro-goals
keep players engaged with puzzles, challenges, and tasks.
When gamifying your digital experiences, remember that each micro-goal should
tie back into the main mission. See each step as an opportunity to interact
purposefully with your customers, educating them about what they can do for
optimal health – and what your product can do to help them achieve their goals.
3. Fast Feedback
Whether positive or negative, give players and customers feedback instantly.
With on-screen notifications, text messages, or emails, gamification allows
you to speak directly with patients, encouraging them to reach their goals,
congratulating them on their latest reward, or providing advice so that they
can improve.

8 Gamification Playbook
4. Transparency
In games, a person always knows where he or she stands. A key feature of
many gamification programs is showing individuals and teams their metrics
and progress in real-time, so everyone knows exactly where they are and what
skills they need to improve. Status trackers, levels, badges, and point totals tell
players where they are within the game itself.

9
For long-term medication regimens, gamification can turn a long series of
morning pill taking into a journey that celebrates each successful week,
bringing a little light and levity to the long, winding road to healthier behavior.
5. Leveling Up
Like badges, leveling up shows how far a player customer has come. While
everyone starts out at square one, in any community there is a sense of
achievement and status to reaching a higher “level.”
Along with level increases, missions and challenges should increase in
complexity or difficulty, allowing player customers to access new and
exciting activities, badges, and rewards.

10 Gamification Playbook
6. Leaderboards
Ranking oneself against others can be a great motivator, whether those
rankings are between people known in real life or real people made anonymous
by screen names. As such, your gamified product should be able to answer
when your player customers ask themselves: “Where do I rank? How can I
do better?”
Leaderboards naturally encourage people and teams to compete against one
another for the top slot, which can create big changes in individual health
and wellness. The most effective leaderboards in a consumer context keep
competition light and positive, positioning an activity as an opportunity for
advancement, not as means of frustration.
7. Badges
As mentioned in the section on Fast Feedback, badges and medals are a great
way to help your customers visualize how far they’ve already come. Particularly
when used as a shareable graphic, badges provide player customers with a
tangible congratulations and something that they can share with their online
social networks.

11
8. Points
Every game has some way of keeping score. Points enable player customers
to track their progress, feel a sense of status, or even unlock rewards like
virtual or real-world goods. Points could be earned for achieving goals, leveling
up, sharing, contributing, engaging, or interacting with the community in a
meaningful way.
9. Collaboration
Games don’t have to be a solo endeavor. It can be more effective to bring an
entire community together to foster collaboration as well as help encourage,
motivate, and congratulate player customers. Player customers could create
teams, and tackle puzzles and challenges together.
10. Community
Truly effective games bring people together, even if the main gameplay is
solo. Through collaboration, sharing achievements, showing badges, and
conversation, a community is built around common participation. This not
only helps maintain interest in the game for the individual, but also helps
the game spread to new people.

12 Gamification Playbook
Desire, Dopamine, and Gamification
There are six broad categories of human desires that games are especially good
at satisfying: reward, status, achievement, self-expression, competition, and
altruism. In the chart on the following page, each desire is matched with the
game mechanic that directly addresses the desire.
Take achievement, for example.
Everyone wants to feel like they have accomplished something. Completing
challenging goals brings with it a rush of energy and happiness hormones that
keep players coming back. Once they’ve succeeded once, they want to keep
moving forward, chipping away at each goal for the satisfaction that comes
from achieving.

13 Gamification Playbook
 Human Desires

Game Self
Mechanics Reward Status Achievement Expression Competition Altruism

Points

Levels

Challenges

Virtual Goods

Leaderboards

Gifting & Charity

The chart above illustrates the interaction between basic human desires and
game play. The green dots signify the primary desire a particular game mechanic
fulfills, and the blue dots show the additional areas that if affects.

14
Like gamification, dopamine, the chemical at the center of our brain’s pleasure
system, represents more than just fun and games. Dopamine has also been
linked to the process of learning. Human beings are simply more likely to
learn, retain, and re-apply information and skills that were taught in a way that
released dopamine in their brains.6
Now, marketers can harness the power of dopamine through gamification to
help educate patients about their condition, their medication, and the benefits
of remaining adherent.
“The addition of game mechanics to a site or application allows you to layer
more compelling user experiences into existing activities. These gamified
activities address and satisfy basic human desires, creating the addictive
experiences that motivate users to take specific actions, and to return more
frequently.”
— Bunchball3

15 Gamification Playbook
Misconceptions and Pitfalls on the Way to
Meaningful Gamification Experiences
While powerful, gamification is not a magic bullet for modifying patient behavior.
It takes time and careful planning to implement an effective gamification
strategy. For the strategy to succeed, marketers must fully integrate game
mechanics into the product, website, or application from inception. SCVNGR
founder Seth Priebatsch put it best when he said:
“I see a real difference between utilizing game mechanics to improve a core
experience from the ground up, and what I call ‘bolt-on gamification,’ where you
basically just tack a badge on to something and call it a day. That doesn’t really
work in my opinion.”7
Instead, game mechanics must be implemented in a way that makes them
meaningful to users. Just because you have a badge-based or points-based
reward system doesn’t mean those badges or points will automatically mean
something to the users. Earning a badge must truly feel like accomplishing a
goal or besting a challenge. Otherwise, the system will feel arbitrary and boring.

16
 BARTLE’S PLAYER TYPE DIAGRAM VISUAL

Acting

Killer Achiever
Players World

Socializer Explorer
Interacting

17 Gamification Playbook
Gamification Success Stories
Companies of all shapes and sizes have begun to use games to revolutionize
the way they interact with customers and employees,” say David Edery and
Ethan Mollick, authors of “Changing the Game.”8
Everything from frequent flyer programs, Starbucks Rewards, Slack’s business
communication system, and the Nike+ family of fitness products integrate
gamification tactics into their products, services, and marketing campaigns.
Let’s investigate three gamification success stories to learn a little bit more
about how these tactics and mechanics can be applied to real world challenges.

18
Reducing Unsafe Driving
Behavior in Sweden
To encourage law-abiding behavior
rather than taking a purely punitive
approach, the city of Stockholm
installed speed cameras to photograph
the license plates of cars abiding by the
speed limit.
Each time they followed the traffic
regulation, motorists were entered into
a lottery. The winner received about
$3,000 from a fund generated by fines
for speeding. The experiment reduced
the average speed on the monitored
road by 22%, proving that gamification
can deliver healthier, safer behavior.9

19 Gamification Playbook
Using Gamification to Reduce Energy Usage
A major Australian utility company that serves more than 640,000 customers
used a gamification- and incentives-based digital program to reduce peak load
usage in a group of trial users. Users were provided with an individualized
energy use goal for each of four peak event periods, based on historical
home efficiency data. Real-time updates were provided using high-resolution
HAN devices. Users could view rewards they received as they met each hour
of their energy use goal, keeping them engaged and motivated through the
peak periods.
A total of four events were held during the 2015-2016 summer season. The
trial resulted in an average peak load shift of more than 30% per user per event.
By using technology combined with gamification and incentives, the utility
company was able to engage their customers around peak-load events and,
at the same time, improve customer satisfaction.10

20
Motivating Patients to Engage with Diabetes
Education and Fill Prescriptions
An injectable diabetes medication franchise added HealthPrize to an existing
CRM program to test the combined impact of applied behavioral economics,
patient education, and rewards with their existing audience. Adherence rates
and engagement levels were compared to the control CRM audience.
Members received daily prompts via text message or email to report their
medication taking. They earned points for self-reporting injections, verifying
prescription refills, taking weekly quizzes and surveys, and reading daily
health tips. Members were also eligible to win weekly sweepstakes and
monthly leaderboard competitions. Points were redeemable for health-related
merchandise in the Rewards Mall.
Engagement was very high, with patients logging in an average of 5 times
per week, and with 75% of patients completing weekly quizzes and surveys.
Adherence increased by an average of 2.9 fills over 8 months compared to
the baseline control, providing the brand with a considerable ROI.

21
How Pharmaceutical Marketers Can Improve
Adherence with Gamification
Buying and taking medication can be a source of dread for patients. It’s far too
easy to forget, especially for those experiencing long-term illness, that these
medications and therapies are helping and valuable. Treatments for chronic
disease tend to benefit patients slowly over time. Such benefits are difficult
to appreciate in the moment when decisions such as refilling on time are
made. Because there is little in the way of instant gratification (or, to use the
terminology of game mechanics, fast feedback), this is one of the reasons
non-adherence rates remain so high for medications for chronic disease.
Behavioral economists call this phenomenon “present bias” – the concept
that we make value short-term benefits over long-term outcomes.

22 Gamification Playbook
There are a lot of other things in life that
get in the way of health. People spend time
on Instagram, taking care of their children,
and working to make money. They aren’t
spending all day thinking about taking your
medication. But gamification makes the
process of adherence more fun and makes
the option of taking a medication
more enjoyable.
The goal of gamification in the
pharmaceutical industry is to turn routine
tasks associated with medication into
something that brings a moment of joy to
the person – treating them as an active
participant in their health, rather than a
passive patient. HealthPrize’s platform has
been designed from the ground up with
these objectives in mind.

23 Gamification Playbook
How HealthPrize Mastered Gamification to Improve
Medication Adherence by 52%
HealthPrize sets the standard for employing gamification techniques in the
pharmaceutical industry. Our platform is built around taking the pain out of
filling and taking prescription medication by engaging player customers with
quizzes, tips, surveys, competitions and sweepstakes that engage, educate,
and motivate.
Points earned by engaging with the platform can then be traded in for real-
world prizes like gift cards, health- and fitness-related merchandise, or even
charity donations.
With its unique blend of gamification, behavioral economics, and consumer
marketing concepts, HealthPrize has delivered average adherence lifts of 52%
over a drug’s baseline rate across indications, drug delivery methods
and demographics.

24
HealthPrize engages their users in a multitude of ways. We integrate
gamification into every aspect of a user’s interaction with the application,
employing informative content with easy-to-understand language delivered
in the enjoyable format of quizzes and positive content, to continuously
engage users.
Additional tactics include:

• Generating immediate interest by leveraging game mechanics and game

tactics to capture a user’s attention – and keep it.

• Employing a balance of repetition and variety of content to maintain

engagement while reinforcing health messages and positive mantras.

• Creating a reward system that provides an extrinsic motivation for

taking medication, while solidifying adherence as a habit through
health-related education.

• Sharing a variety of content types, from static messaging to interactive

activities, to keep patients looking forward to the next challenge.

25 Gamification Playbook
All of this, when implemented in a product designed around creating positive
habits, has transformed the process of taking medication from something a
patient has to do into something a person wants to do. And as a result, our
pharmaceutical clients’ patients see significant increases in both primary
adherence (filling a prescription for the first time) and secondary adherence
(continuing to refill over time).

26
Extrinsic vs. Intrinsic Motivation
Many of the arguments against gamification center on the idea that it impacts
extrinsic motivation only. Extrinsic motivations are driven by external rewards,
such as earning points or moving up a leaderboard. These types of motivations
can deliver quick changes in behavior, but as the novelty of the game elements
wears off, players or patients may revert to their original habits.
HealthPrize, though, uses gamification to help establish healthy habits in the
first place, combined with education to enhance intrinsic motivation so that
patients maintain their healthy behaviors in the long term, even once no longer
enrolled in a HealthPrize program.

27 Gamification Playbook
John Ragland, Chief Product Officer at HealthPrize, puts it this way:
“We blend in gamification to start to reinforce positive health messages so that
we shift the action of taking the medication from something they do to get
an external reward into something they want to do internally.” The education
component of the platform – the surveys, quizzes, and daily tips – is what
ultimately drives persistence.”
When just a 10% increase in medication adherence could result in billions of
added revenue for the pharmaceutical industry, results like HealthPrize’s 52%
mean increase in adherence are no small matter.

28
Connecting Health and Healthy Behavior
Human beings are notoriously bad at making decisions that are better for them
in the long term, and it’s no wonder. It’s difficult to conceptualize the connection
between not taking hypertension medication today and a stroke that may or
may not happen in five years. But, in the healthcare community, the connection
between these two things is clear.
Gamification allows pharmaceutical companies to positively impact their
patients’ behavior and help them live healthier lives. In the process, these
companies can enjoy healthier revenues. It’s a clear win-win strategy.

29 Gamification Playbook
Glossary of Terms
1. Game: A form of play or sport, often competitive. Played according to a set of rules, the
winner of which is decided by skill, strength, or luck.
2. Gameplay: The tactical aspects of a game, which includes the way that it is
played, game mechanics, and, often, plot.
3. Game Mechanics: A set of rules or methods employed within a game
that dictate how a player interacts with the game. An important part
of gameplay.
4. Game Dynamics: The player’s behavior and/or experience that arises
while playing a game. Sometimes used interchangeably with game me-
chanics, although they refer to slightly different things.
5. Ludemes: The conceptual elements of a game, often summarized as its
rules. Defines what is possible within a game.
6. Extrinsic Motivation: A drive for a reward that is external to the individual
performing the task. Extrinsic motivators include prizes, status, and
monetary rewards.
7. Intrinsic Motivation: A drive for a reward that is solely internal to the individual performing
a given task. Intrinsic motivators include satisfaction, learning something new, and pride in oneself.

30
References
1. Firlik, K, Moore T, & Chawla, S. (2016). Estimated Annual Pharmaceutical Revenue Loss Due to Medication
Nonadherence. Adherence564.com. Capgemini Consulting and HealthPrize Technologies.
2. Cugelman, B. (2013). Gamification: What It Is and Why It Matters to Digital Health Behavior Change
Developers. JMIR Serious Games, 1(1), e3.
http://doi.org/10.2196/games.3139
3. Malone, T. (1980). What Makes Things Fun: A Study of Intrinsically Motivating Computer Games.
Xerox, Palo Alto Research Center.
4. Bunchball (2017). Gamification 101: An Introduction to the Use of Game Dynamics to Influence Behavior.
5. Burns, M (2012). Dopamine and Learning: What the Brain’s Reward Center Can Teach Educators.
Scientific Learning Fast ForWord.
http://www.scilearn.com/blog/dopamine-learning-brains-reward-center-teach-educators
6. Hamari, J., Koivisto, J., & Sarsa, H. (2014). Does Gamification Work? – A Literature Review of Empirical
Studies on Gamification. In Proceedings of the 47th Annual Hawaii International Conference on System
Sciences, Hawaii, USA.
7. Van Grove, J. (2011). Gamification: How Competition Is Reinventing Business,
Marketing & Everyday Life. Mashable.
http://mashable.com/2011/07/28/gamification/
8. Edery, D & Mollick, E. (2008). Changing the Game: How Video Games Are Transforming the
Future of Business. Pearson Education, Upper Saddle River, NJ
9. Sorrel, C. (2010). Swedish Speed-Camera Pays Drivers to Slow Down. Wired,
https://www.wired.com/2010/12/swedish-speed-camera-pays-drivers-to-slow-down/
10. Bidgely. (2016). Automated Demand Response with >30% Peak Load Shift. Bidgely, Inc.

31 Gamification Playbook
Discover how HealthPrize uses gamification to
engage, educate, and motivate patients.

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