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What Should Your Copay Program Utilization Rate Be?

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 copay claims / TRx’s) depend on many factors, the largest being the percent of business coming from each channel. Brands with a higher percentage of govt. business will naturally have lower overall utilization rates because, for the most part, government insured patients can’t use copay. Other factors impacting utilization rates are managed care coverage, the brand’s objectives for the program, net margin requirements, and the brand’s adherence and abandonment rates.

Everything here depends on the specific brand’s situation.  Some brands have managed care issues with a large percentage of patients seeing NDC blocks and step edits at the pharmacy. The offer itself and the channels used to distribute it also have a lot to do with utilization. A brand utilizing electronic delivery of their coupons such as with Relay Health would have a very high utilization rate, but at the same time since every patient gets the discount, this program would be taking a heavy toll on their margin.

There is no “one size fits all” answer to this question. Every product is different and has different needs. Measuring your program’s utilization rate vs. other programs may lead you down the wrong path.    

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