Is Your Copay Program Costing You More Than It’s Earning? Keep These Top 5 Metrics In Mind

Is Your Copay Program Costing You More Than It’s Earning? Keep These Top 5 Metrics In Mind

Aug 11, 2017


Q4 is approaching and you’ve been tasked with analyzing the success of every initiative your brand has executed throughout the year. Working with a range of internal and external partners, your biggest challenge now lies in calculating the ROI of each initiative. Your end goal is clear – use this year’s insights to update your strategy and deploy your marketing spend more effectively in 2018.

No matter the initiative, there is one market dynamic that impacts them all: payers are increasingly shifting the cost burden onto patients. As a result, your copay program has grown from being just another tactic into a key element of your access strategy, an indispensable tool for sales reps, and one of the biggest line items on your budget.

Yet, with all the focus on tactical and strategic planning, is it possible that you do not fully understand the ROI of your copay program? If you aren’t assessing your program with the same rigor as the rest of your business, it’s likely you are spending more than you are earning.

While the strategy and goals of every copay program vary, we’ve found that the top 5 essential metrics to track ROI stay the same.


1. Patient Abandonment: At its core, the objective of any copay program is to ensure a patient doesn’t walk away from the pharmacy without a script because of cost. As you assess the effectiveness of your copay program, it’s imperative to look not just at the average abandonment rate, but also at the impact the program had on individual patient behavior. The change in potential abandonment for a patient bought down from $100 to $30 is going to be much larger than for a patient bought down from $40 to $30.



2. Patient Adherence: Another primary benefit of copay programs is that patients who participate are more adherent than those who do not. One reason for adherence is due to the patients’ lower copay responsibility. Another reason is that the patients are more engaged in their therapy. As you continue to assess a program’s success, it’s essential to understand and measure the additional adherence seen from each copay program. 



3. Program Cost: Many times the cost of a copay program is measured by the amount paid to buy a patient down, in other words, “the benefit spend.” But in actuality, the cost of the program is much more. Key costs to take into consideration include: the pharmacy transaction/adjudication fees, management fees, reporting fees, setup fees, web hosting/design fees, activation fees, call center management fees, and custom reporting fees. It’s only when you take an activity-based approach that you can truly gauge how much your program is costing you.


4. Rebate Cost: Arguably one of the most overlooked variables in measuring the ROI of your copay program is the impact of payer rebates. All too often it’s assumed that the copay benefit is the only cost attributable to a copay script. However, the reality is that many of those copay claims also have payer rebate costs associated with them. Whether looking at the ROI of an entire program, the ROI for one patient, or the ROI for a single script, it’s essential to overlay rebate costs to fully understand the net impact of the copay program.



5. Impact on Physicians: Shifting our focus away from the impact copay programs have on the patient, we realize that copays also have a meaningful impact on physicians.  When looking at a copay program ROI, considering the effect on physician prescribing behaviors can help you understand whether or not your copay program is driving the all-important “halo effect.”

Regardless of whether your copay program affects 6% or 60% of your TRx – taking a deeper look at the program ROI is an essential component of planning and designing the right offer. As you take a more in-depth look at your program, keep these top 5 metrics at the forefront of your mind.


If you would like to learn more or have any questions, contact us at any time.

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The Truveris Patient Access Services team is committed to providing insights and analysis to help pharmaceutical brand teams make the most informed decisions. This post on important copay program metrics was one of our most popular last year. We’ve updated it to better reflect the most current statistics and information from across the prescription drug landscape.



Posted by: Jonathan Lanznar

Jonathan Lanznar is a member of Truveris’ Life Sciences team. In his role as Director, Jon leads the company’s efforts in delivering patient access programs for pharmaceutical companies. Jon has a BA from Emory University and an MBA in Healthcare Management from the Wharton School at the University of Pennsylvania.