How does a price increase impact your copay offer?

Written by Al Kenney on 01 August 2016. Posted in Co-Pay Program Optimization


I have been asked many times how a brand's upcoming price increase will impact their copay program. Obviously they are asking because they don't know...and for good reason! This is not a simple answer to get to. Every brand is different and so is the maze of their managed care contracts.

Many contracts have clauses written in to address price increases. This makes it somewhat easier to understand the ramifications of a price increase, but many contracts don't have these clauses. In these cases, each PBM will decide the implications on a case by case basis. Chances are that the pricing action will not change your tier status but if the PBM passes on some or all of the additional costs to patients via increasing their copays, then there could easily be an impact on the cost of your copay program.

The magnitude of the cost impact will depend on the way your copay program business rules and cap are structured. I have seen both ends of the spectrum. If you know that you will be taking a price increase sometime soon, you should assume a higher patient OOP cost and plan for it in your programs business rules. It could save you a bundle.