All too often, when manufacturers design copay assistance programs, they take a one-size-fits-all approach. This may make it easy to design and operationalize a copay program up front, but over time, shortcomings and inefficiencies in the affordability program begin to emerge. In the end, these drain value from the brand through opportunity costs, interruptions in the patient journey, and long-term viability of the program. Being nimble and proactive by continually fine-tuning copay card programs can protect a brand’s value and improve the patient experience.
Rather than rely on a single static design, a robust patient-assistance program would account for a patient’s specific type of coverage to maximize the reach of the program; create differentiated offerings between a first fill and refills; and target offers to adjust for new competitive challenges. Adopting these three approaches can help manufacturers implement more innovative patient access strategies to ultimately build a more effective affordability program.
1. Optimize Offers by Type of Coverage
One common misconception is that copay assistance offerings for a particular drug should be the same across all patient types. While this may aid with program simplicity, it can have a negative impact on gross-to-net ratios for the product and ultimately make the program unsustainable. A better approach optimizes program design by accounting for various types of patient insurance coverage. It also can be helpful to understand how payers advantage or disadvantage other products within the same therapeutic area, so that the design of the program creates an opportunity to grow market share. These are proactive methods that can be vital to the cost-efficiency and sustainability of an affordability program.
How would this look in practice? Often, patients with robust benefit coverage don’t need (or qualify for) the support offered by a copay card. By reserving the benefit for those who need it most and by designing business rules on the basis of coverage type and the economics of the individual prescription, the manufacturer has tighter control of the copay–benefit spend. This creates efficiencies that allows the brand to reach more patients.
2. Differentiate First Fill and Refill Offers
Many strategies can help drive prescriptions and adherence. One such strategy is to provide free product, whether through zero-dollar copay cards or a free–product voucher. “Free” is a powerful word and can be a relatively easy way to get prescriptions written, but converting the patient’s first fill to consistent refills requires some thought.
Free–product vouchers come with some pitfalls. One in particular is a lack of understanding about a voucher’s real impact on prescriber behavior and the choice of a treatment regimen. A single copay card with a differentiated first–fill offer and a separate set of business rules for refills improves the patient experience while giving the brand better visibility into its patient population. When combined with easy activation strategies or a well-designed patient–engagement tool, this program design can generate a wealth of valuable data and allow the brand to make a greater impact.
3. Provide Targeted Copay Offers
Another way to improve a copay card program is to target its offerings to specific populations, such as those living in different geographic locations or who are covered by certain payers. Marketplace competition, patient populations, and payer strategies toward products can change over a drug’s lifecycle. A sustainable copay assistance program should be able to pivot when these changes pose significant ramifications for a brand’s viability. Copay-assistance design can help brands to account for these dynamics, such as when a payer changes coverage policy for a product.
Designing and maintaining a copay-assistance program to support brand goals can be a daunting task. But with the right partner, innovative and dynamic strategies can be deployed to generate a better understanding of the population, improve prescription economics, and provide patients with access and affordability.