Is your brand going LOE in the next 18 months? If so, it’s time to plan both your final years’ copay program structure and your “post LOE” copay program structure as well.
Since you will most likely begin to lose managed care coverage, a big consideration will be planning your copay strategies for the coming two years (last year pre and first year post LOE).
Not that long ago when a brand went LOE, it was pretty much the end of their copay program. All support was pulled, and managed care coverage was lost. These days, it’s a bit different. Yes, technically it is the “beginning of the end” but “the end” is much further away.
Your LOE event will result in a significant sales decline of as much as 90%. The brand’s share will take a dip as soon as the generics hit the market, but that doesn’t mean all of your profitable years for the brand are over. Normally a brand will start their LOE planning process about two years before their expected patent expiry date. Copay programs should be planned and structures decided on before you are one year out.
Brands usually start by trying to preserve brand equity and patient loyalty. For example, three to six months before LOE, a brand could start to lessen reliance on reimbursement from health plans by transitioning patients to a copay card to drive affordability and reduce patient out-of-pocket (OOP) expenses to levels equivalent to generics. This may help maintain sales volume.
On the copay side, it’s important to plan your program’s offer for the final year pre-LOE to get the most you can out of the brand. Often brands are trying to maximize profits so their programs may not be as lucrative. Maybe they drop their offer for cash paying patients as well.
Once the brand goes LOE, brands should not assume everything is lost! Yes, sales will continue to decline year over year, but many brands have been successful managing their sales declines and maintaining profitability for 5+ years post LOE.
There is a lot of data needed to perform the proper analysis to understand and predict the outcomes of proposed changes. You would need claims, sales, and internal cost data along with some helpful modeling technology at a minimum. But a little extra planning at the proper time can go a long way and generate more brand profit than you may have had otherwise!