Technology in business

Your Performance Measurement Tool Needs to Include more than Copay Data

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 and many reports add no extra value for the brand.

For example, knowing how many claims you have coming in each month and their cost is one indicator of program performance, but it doesn’t answer many questions you need to know such as:

  1. How is your program is doing from a utilization perspective (percent of overall TRx’s)?
  2. What is the profitability of your claims by each patient type (commercial, insured not covered, and cash)?
  3. How is your Relay Health program performing vs. your traditional copay card program?
  4. How has the profitability of each script filled with a coupon changed over time (current month, YTD, and since program inception)?
  5. How do coupon redemptions compare to TRx’s by custom sales territory or region?
  6. How does coupon usage differ based on physician segmentation or by type?


The problem is that to get this type of information, you likely need to go into many different reporting portals to pull the information and then manually create your reports.

To better understand what is happening, you need to be able to put all your relevant, important data into one tool. This is why a copay vendor’s claims reporting is insufficient for your brand’s needs. It’s not the copay vendors’ fault as many vendors have done a fine job with what they have…

The issue is they can only report on the data they have… claims data. Brand teams, on the other hand, have a much larger task than just tracking individual copay claims and spending. They need to manage their brand overall and the claims data is only a small portion of what they need to look at in order to do an effective job.

At a minimum, brands also need to consider internal financial cost data and IQVIA or Symphony data to see what is selling through and where. Many times, brands also have multiple vendors implementing different types of copay programs (card versus electronic delivery for example). Until you see all these data sets together, you really can’t determine how well your program is performing.

We’ve seen a few “universal databases” developed by clients but even then, the database lacks a good reporting tool to get the information out to the brand teams that need it most to effectively manage their business. As a result, we see clients getting custom reporting from their copay vendors – spending thousands per month in extra reporting fees…and still not getting all the key information they need in one place.

Having copay data from different vendors all in one place allows users to see the interaction between programs and how a change in one program impacts others. You need to be able to compare your claims versus actual market sales and track utilization rates over time. By adding internal cost information, you can see real gross to net information and real program ROI and how program changes impacted these metrics.

Capturing the data and having it all in one central location allows you to analyze to a deeper level (by market or by sales territory) and even track spending down at those levels. It’s easy to see how quickly a solution can morph from a copay related tool to an essential brand dashboard tracking many key KPI’s. It is important to work with a vendor that understands your brand’s issues and can build a custom dashboard that allows you to quickly see and access all the information you need.

Don’t be held captive to the status quo… Next time you think about how limiting your copay portals are, remember there is a vastly superior mousetrap out there offered by an independent third party which would allow you to quickly translate your data into knowledge to drive your decisions, giving you a competitive advantage.

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