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Improve your Brand’s Net Margin with Copay Program Optimization

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 of spending happening in this area, everyone knows the potential is there but without the right tools, savings can be very difficult to find.

I’m not just talking about spending less as many times this results in lower sales as well…net/net you’ve gotten nowhere. There are three key areas related to copay where you can improve your overall profitability:

  • Optimizing your programs and patient offers
  • Closely monitoring your copay program’s financials
  • Auditing your claims to help identify fraud and improperly processed claims

Optimizing your programs and patient offers: There is nothing wrong with the information that copay vendors report on except that copay claims data doesn’t tell the complete story you need to ensure your copay program is optimized. At a minimum, you need to add your internal financials into the mix so you can plan and track any estimated changes to your bottom-line profit. Do you really care that bringing your $20 offer down to $10 would increase your claims by 10% if those claims are not incremental? Making that change may take claims up but the result may be lower profit. You need to not only identify the pricing inflection points but also overlay your financials to properly plan and optimize your copay program.

Closely monitoring your copay program’s financials: Again, there is a place for the copay reporting you receive but it is not enough to monitor to the level you need, especially if you have multiple copay program vendors. Being able to see how one program impacts another in one tool is key. Adding in your financials for a monthly profitability update, as well as adding in your TRx data will enable you to monitor things at a granular level so you can identify issues and make changes when needed.

Auditing your claims to help identify fraud and improperly processed claims: If you have never done a copay audit, you don’t know enough about what is happening at the point of execution. Every program should be audited at least every two years to ensure that program execution at the point of sale is following the business rules you set up. It’s always best to have an independent third party do the audit rather than the copay vendor that is running the program as that will not give you a high likelihood for success.

Doing one or more of these key analytical processes outlined above could pay off handsomely when trying to increase your brands profitability.

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