Case Studies in Patient Incentives


Re-structuring a Complex Offer to meet their Patients “Donut Hole” needs for a Major Specialty Pharma Brand


A major pharma manufacturer has a small share product in the highly competitive RA category. The brand had one of the highest growth rates of all the RA brands

The current offer (essentially a pay $0 program) provided the greatest patient savings over a one year period in the category, but several large competitors also offer attractive savings via their patient incentive programs (covering >95% of patients at no out of pocket expense for the year).   A more productive offer was sought that still maintained or increases that OOP number. Another key objective was to investigate any drops or tolerance level trends for OOP payments at different levels.

Our Solution:

The brand implemented our National Co-Pay Optimization Model which would not only forecast different offer scenarios but give them a complete financial picture of each of the proposed offer. This model also recommends the best offer for the brand based on their specific brand objectives during each portion of its lifecycle.


A full analysis was performed and it was discovered that the most productive change it the brand’s offer was to redistribute their annual cap. Instead of having a structured monthly and additive annual cap where many times the patients exceeded the cap on their first or second use, we suggested a more flexible cap that started higher on the first fill and then was reduced over the course of their therapy.

This ensured that the cap was high enough when the patient had not yet met their deductible and was reduced when co-pay deductibles had been met. There was however a “sticking point” which was the client could not meet their profit objectives by maneuvering the cap. In order for this strategy to work the brand team needed to realize that their patients needed to have “some skin in the game”. The model showed the brand didn’t need to have a $0 offer and they could come up to at least a $10 “patient pays first” co-pay offer. The savings gained on the this offer was more than enough to fund the cap structure change and deliver the increased profitability the brand was looking for!