Answering some common questions on patient copay programs

Written by Al Kenney on 15 May 2017. Posted in Co-Pay Program Optimization


There are two things that most brand managers can say about copay…. a) they probably have a program and b) years later they still have many unanswered questions about what these programs are doing for their brands.

Here I will try and tackle the most frequently asked questions about copay programs:

Are these programs worth your spend? The short answer here is yes…on average, these programs are certainly worth your spend since they lower the financial barriers to filling scripts and they help many patients. I addition, if structured correctly, these programs can increase patient trial and adherence which is good for the brand long term. The key is getting this growth while still meeting your financial objectives for this year and beyond.

Do copay programs generate increased adherence? Yes, copay programs will most likely generate increased adherence by lowering patients’ financial barriers and lessening the impact of cost. Of course there are many reasons why patients are not adherent and cost may not be the driving factor. Even If all patients were given their drugs for free, we’d still be talking about how to increase adherence! With limited funding for a copay program, you will have to make tough choices about how to structure your program to meet your objectives: For example, do you set up the program to give something to everyone or to give more to the patients who need it most? And what should you do about your insured not covered patients until they meet their annual deductible? Etc.     

What is a good ROI number for programs like these? What you may find surprising is that some of the best ROI’s we have seen are not necessarily the best programs for the brand. Brands that focus purely on ROI are often not happy at year’s end since program ROI doesn’t consider the impact on the total business (Total scripts, total revenue, impact on adherence and trial etc.) The key is to use ROI as one of the KPI’s you might look at in addition to objectives for trial, adherence, sales, and gross to net. You need a well-rounded set of objectives to shape a well-rounded program.  

What’s the best patient offer for my brand? This one is a loaded question and my standard answer is that the best offer is the one that best meets all of the brand’s annual objectives. That is why planning out your annual objectives in detail should always be your starting point. Once your objectives are set, our models can optimize the program to meet and exceed the objectives. Changing your objectives slightly may mean changing your offer as well. Just because an offer is lucrative doesn’t mean it will meet your most important objectives. For example you might meet your sales goal but fall short on your profit goal. But if you don’t have a stated profit goal you most likely will never reach it!   

These programs generate so many questions and the best way to answer them is to have not only good data but also good tools to draw out the insights. Please feel free to reach out to me with your copay program questions!