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 health plan, they most likely will have to pay more than the advertised $15 out of pocket.
This will happen when the maximum payout amount (the cap) isn’t set at an amount to cover all the patient’s out of pocket expense. Keep in mind that the cap amount is usually hidden from view in smaller text and many times is on the back of the card in the fine print.
Let’s take a look at two offers; a pay as little as $5 with a $100 max cap, and another with a pay as little as $25 with a $150 cap. The $25 offer, on the surface, seems inferior to the $5 offer, certainly from a face value perspective, but depending on the patient’s insurance coverage, it could actually be the other way around. What’s most important to a patient with high out of pocket costs is the cap (maximum value of the coupon). If a patient has a $150 out of pocket amount and uses the $5 face value card, they will have to pay $50, whereas if they used the $25 card which offers a max benefit of $150, they would only have to pay $25.
The offer structure is of course set up that way by design, as most brands can’t afford to cover every patient through their entire high deductible period. Some patients are surprised to have to pay more because they interpret the “pay as little as” to mean “this is the amount you will pay.”
More surprised than the patient is their physician who probably spent little time in the past looking at these cards and even less time trying to figure out how the card would impact their patient’s out of pocket costs at the pharmacy. However, after hearing an earful from their patients over the years, these physicians are now paying a little more attention to the caps.
The lesson here is the cap can be the most important part of your copay offer for patients in HDHP’s. Next time you have extra budget to spend, don’t rush to bring your face value down while leaving your cap the same as this has little impact on the patients who need it most. Focus on what offer gets you the best patient coverage to the face value of your offer. You’ll make both your patients and physicians happier!