Copay programs and the issues that surround them are complex. Come here to learn about ongoing best practices in copay program optimization and what’s new in the industry.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Here we will try and tackle the most frequently asked questions about copay programs: Are these programs worth my 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. In addition,
All brands should strive to get the most from their copay program. We have been helping brands optimize their copay programs since copay began in the industry. There are many places where you can get tripped up when it comes to developing your program. The issues that we have found
What is your definition of copay program optimization? Many potential clients ask us how we define copay program optimization. We don’t actually define copay program optimization… our customers define it for us. The copay program should support the brand and program objectives and not the other way around. This involves
One of the questions we are frequently asked is what a brand’s copay program utilization rates should be? What are the brands that are “doing really well” getting? As my grandmother once said “what is good for the goose might not be good for the gander!” Utilization rates (# of
Years ago, pharma marketers and senior management teams were asking themselves if copay programs were worth having in a brand’s repertoire. Over the years it has become clear that copay programs have provided a tremendous benefit for patients and therefore brands also benefit from lower abandonment and higher adherence rates.
There are many commonly used KPI’s for planning or evaluating copay programs. Here is my list of a few of the commonly used KPI’s and examples of why each one can be very misleading if looked at individually: 1. Cost per Claim – The cost you paid on average for
There is a major flaw in the way companies evaluate their copay incentive programs and it can cause a brand to overspend. When it comes time to renew a program, a brand may choose to increase their patient incentive offer intending to increase sales (lower the face value from $20
You know your patient copay subsidies are powerful tools for your brand and can make all the difference in the world for your patients to both start and stay on therapy. But did you know your copay offer can also be used to attract the right mix of patients to
As you likely know, a “specialty” medication is a drug that treats rare and/or complex diseases and disorders. There are many complexities and challenges associated with getting patients on a specialty medication and keeping them on therapy. Typically, a patient will need a prior authorization, step therapy or some other
There are many things you must consider when planning your copay program, but one of the most important things is a step that is skipped by the majority of brand planners. To plan programs and project program cost you need to know what your patient’s OOP cost would be before
Now more than ever, you’ll need to understand and pay more attention to the business rules in your copay program. This is an essential step to ensure all your strategic thinking gets executed at the pharmacy exactly as you thought you had defined it. There are many examples where loosely
If you are a pharma manufacturer today, you most likely have a patient copay assistance program in place as it is a necessary piece of your patient affordability strategy. You may feel these programs are set up with pretty strict business rules which should ensure that your monies are going
A quality copay program analysis considers the influence of high deductible health plans on patient out of pocket costs. It’s not like the old days when you could just go to your managed care group and they would say 92% of all commercial patients were covered to an average out
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