Accumulators and maximizer programs are the most recent tools pharmacy benefit managers (PBM’s) have developed to reduce costs for payers. First, here is a quick review of the two programs: Accumulators: With an accumulator program, the patient’s out of pocket amount for the medication will be adjusted to reflect the benefit provided by the manufacturer’s […]
We see many brands launching these days with copay offers which require a very small or even no out of pocket amount to be paid by their patients. There are really two questions here; 1) What is the right initial offer? and 2) What is the correct timing to tweak the offer? You see many […]
Through our work doing copay program optimizations and audits, we have found there are a few key components that increase the likelihood a program will be targeted for fraud by cunning, mostly independent pharmacies. Copay programs with a high annual cap are often targets for fraud. It’s the flexibility and amount of the annual cap […]
Most brands with copay programs are stuck with only copay claims reporting from their copay vendor which only provides part of what is needed to understand what is really happening within the program. Claims data by itself leaves a lot to be desired as it’s too narrow a data set and many reports add no […]
Our copay program optimization models, brand tracking tools and claims audits are recognized throughout the industry as the platinum standard for planning, evaluating, and optimizing copay programs. Our comprehensive approach to copay ensures program structures are optimized prior to in-market execution, reporting and analysis is streamlined, and business rules are being executed properly. As an objective third party, we provide key insights to marketers, finance and senior management teams allowing them to make more informed decisions that provide a better ROI.
We know our clients are extremely busy and that is why we provide them with “turn-key service” with all-inclusive pricing. Not only do we provide a full analysis including advanced tools, models and recommended next steps, but all engagements include our team as a resource for ongoing support.
The result is the best of both worlds. Our clients have our team working behind the scenes and they also have full access to the tools if they want to review the data on their own. To assist in the review, all tools include guides that provide an overview of the process, a definition of terms, and a synopsis of the results.
Most brands and companies today are looking to improve their brand’s profitability. Many are looking in the same old places to try and squeeze out an extra percentage point. But many pharma brands are either reluctant or just don’t have the capability to try and find savings in their brand’s copay program. With the amount […]
Brand lifecycle: The often forgotten, but major consideration when structuring your patient copay program. There are many factors influencing your copay program but a key driver impacting your objectives is where the brand is in its lifecycle. Your objectives for the brand will certainly be different depending on which lifecycle stage your brand is in: […]
Situation: A major pharma company needed to trim $30MM in copay program spending company-wide and still maintain their growth. The company came to Alpha 1C to optimize their copay programs across their product portfolio. Objectives were as follows: Maintain sales growth while reducing cost by $30MM (-16.6%)…
Situation: A leading brand had recently made a change to their copay program after working with the Alpha 1C team to optimize their program. Given the visibility of the brand within the company, management was very focused on overall brand performance and tracking the results of the program change vs. the forecast…
There are many reasons to check the overall health of your patient copay program by completing a copay claims audit through a knowledgeable, objective 3rd party. One of the primary issues is that the NCPDP software which pharmacies use to process patient benefits has not been significantly upgraded in quite some time. And since this […]
Most pharma companies have never done a copay claims audit looking specifically for incorrectly processed claims and pharmacy fraud. This is an interesting fact since spending on copay programs was almost ten billion dollars in 2022. Audits can deliver millions of dollars of savings along with big improvements in gross to net. Copay claims audits […]
Our unique copay program optimization models recommend the best copay offer to meet a brand’s objectives. Our annual planning approach provides unsurpassed insights into the levers that can be changed to optimize copay program results.
Ask most pharma teams if they are doing “copay audits” today and most will say they are. Most don’t realize there are two different types of copay related audits. A copay vendor audit is the one everyone is most familiar with and is most often performed by one of the major auditing firms. A copay […]
We provide the comprehensive tools and oversight to allow ongoing tracking of performance metrics across multiple data sets and vendors via customized flexible dashboards. We identify issues as they happen, and facilitate ongoing refinement.
Claims audits are a critical part of copay program optimization. We use a checks and balances approach to uncover costly waste and fraud and provide insights into whether pharmacy execution matches the program’s business rules.
These PBM programs are very confusing to everyone. Understanding each one, how they are different, and how they impact both pharma manufacturers and patients is important. Accumulator & maximizer programs may look alike, but they are not…
When we’ve worked with a launch team after their product gets through phase 2, the team often already has a TRx sales forecast and then they want to plan their copay program. Our first question always is…What copay offer did you assume when putting together your forecast? To date, the answer has always been the […]
Monitor the most important brand results Alpha 1C’s customized reporting dashboard consolidates key metric reporting including copay claims data across brands, channels and vendors in one simple, flexible tool. A wide range of trended data from any database can also be incorporated, including TRx trends, physician segmentation details, media activities, as well as geographic and […]
Plan your optimal copay offer BEFORE in-market execution Alpha 1C’s Optimal Offer Model is a customized, interactive, copay program planning tool that predicts the impact of program changes via turn-key “what if” simulation capability. Our models provide a forecasted P&L for each of up to 1,500 scenarios – allowing our clients to see the potential […]
Incorrectly processed claims can quickly add up to millions of dollars of wasted spend. A copay claims audit uncovers and quantifies costly “processing errors” and fraud and is a critical step in copay program optimization. Pharmacies manipulating claims are identified for follow up and can be continually monitored.
The mindset of most pharma executives and brand managers is to start off with the best copay program possible for a launch brand. Most translate that to mean the copay program with the lowest patient out of pocket. Looking at the current marketplace for copay programs, they will see many brands launch with a $0 […]
Situation: A major pharma manufacturer contacted us to evaluate whether the cap on their copay program was optimal given their objectives and patient base. After receiving a claims file and utilizing our copay program optimization model to evaluate different patient offer scenarios, it was determined there was a very high…
Many copay programs have an INC offer component but many of our clients don’t differentiate the two types of patients typically grouped within their program and this can cost them. INC can be two types of patients: Insured Not Covered 1 (INC1) – have commercial coverage but are also in a high deductible health plan […]
A leading pharma manufacturer was launching a new entry into a soon-to-be very competitive and fast-growing category. Our Optimal Offer modeling solution was chosen to project the impact of hundreds of potential copay offer structures. Our oversight resulted in significant changes to the copay program they were considering…
There are many ways that your program can be manipulated at the pharmacy level (retail or specialty pharmacy). It doesn’t take much for an experienced pharmacist to get around your established program rules if they are determined to do so. Your business rules can leave the door open for experienced pharmacists to twist your program […]
For years, one of the popular ways to distribute copay offers has been via sales reps to your targeted physicians. A copay program is a major selling point for the reps and it’s a fact that the combination of receiving both a script and a copay card is a powerful motivator encouraging patients to fill […]
We always find that there is confusion among brand team members when we talk about abandonment rates. Many people confuse abandonment rates with reversal rates and think they are one in the same… they are not! Let me take you through the explanation of how each is calculated. We start with the written scripts shown […]
How much impact do competitive offers have on your brand? The quick answer is competitive offers certainly impact your brand to some degree but at different levels depending on the category and your brand’s position in it. We have found most brands put much too much stock in their competitor’s offers which result in the […]
Follow the leader has been a strategy used countless times over the centuries but the vast majority of times it has not worked out well for the follower. These days when we talk to brands, many say the same thing: “We just match or try and beat our competitor’s copay offer”. That strategy sounds like […]
A brand that was quickly approaching LOE was under pressure to support a case to keep their copay program in place in order to maintain the persistancy of their patients. Using our goals-based copay optimization modeling process, we were able to forecast the impact of continuing or discontinuing the program…
There is a push as an industry to do everything electronically. The prescribing process is just one of many that is being overhauled. This will allow better tracking of script writing from the physician’s office through the delivery of that script to the pharmacy and then hopefully into the patient’s hands. All of this is […]
A question we are often asked is: “should mobile be a delivery channel for your copay offers?” This is when the coupon is sent directly to the patient’s smart phone so it can be scanned by the pharmacy directly from the phone’s screen. As a starting point, I’ll point to the following facts I found […]
There is a new trend out there in copay – have you seen it? A few select companies and brands have begun offering real copay offers to Medicare patients in an effort to provide copay support to more of their patient base. These offers are not just the one-time “free trial” offers that we are […]
Pharma marketers have been overly focused on the face value on their patient offers. This is the price that patients and physicians see on their copay discount cards. Everyone is focused on the “pay as little as” $15 offer and then reality hits at the point of purchase. If the patient has a high deductible […]
For years, many have asked whether there is a positive “halo” effect related to copay programs…and if so, where are the key areas of impact? Many have pointed to a variety of potential positive impact areas including: Although many believe in a “halo” effect, there has never been a major study done to quantify the […]