Is your patient copay program subsidy reaching the correct patients?

Written by Al Kenney on 28 March 2016. Posted in Co-Pay Program Optimization


You may have heard me talk a lot about how to properly utilize your copay program to deliver the results you need. The most effective way to do this is to utilize your copay program as a safety net in conjunction with your existing managed care coverage.

Your copay offer should work together with, not against, your managed care strategy. When your copay program overlaps, or conflicts with your managed care strategy, you’ll find a lot of wasted spend. This is not an effective approach as it won’t deliver the results you need and certainly won’t deliver the “holy grail” of copay programs: generating incremental volume and adherence increases for your brand.

We give our clients several unique “looks” at their spending through our advanced analysis and reporting tools so they can easily spot issues and opportunities. One of most effective views is a chart showing the patient copay amounts (pre and post copay card) as well as the program spending by copay group. Looking at the chart you can see the average patient OOP based on managed care contracts in the blue line and the average patient OOP after the copay card in the tan line. The bar graph shows the amount of spending for the brand against each of the patient copay groups. The example we show here indicates that $9.1MM was spent on the patients with $150+ copay OOP.

The trend you see in this example is exactly what you want and hope to see…bar graphs are getting larger from left to right which means there is a higher percentage of total program spend going towards the patients who actually need it most (those with high copays). Depending on how the spending is spread, this can deliver high incremental volume results. You would think that the chart would always look this way…but think again! Many types of program offers actually focus spending on patients with lower copays (those patients who would have filled anyway). With a graph like this, you can easily see if you are putting your budget where it will get you the best result for your brand. Putting your spending against patients with higher copays will ensure higher incremental volume and higher ROI for your spend.