Over the past several years, pharmaceutical brands have been navigating an increasingly complex and challenging patient access landscape. It has become more expensive than ever for pharma manufacturers to support patients with copay programs and patient assistance programs (PAPs), while they continue to pay a larger proportion of rebates to pharmacy benefits managers (PBMs). Each year, new challenges to patient access emerge – prior authorizations, copay accumulator and maximizer programs, step therapy, and so on.
Year over year, pharma brands are investing more in solutions that help mitigate these patient access challenges, but they are still experiencing inflating gross-to-nets. Patient access has become a cycle of countermeasures with the goal of driving patient access, which has made it harder than ever for patients to get and stay on therapy. Within this environment, pharma brand teams must focus on innovative solutions that position their brand for optimized success in market.
3 patient access strategies to avoid lackluster gross-to-nets
To stay competitive in the current market landscape, pharma manufacturers are turning to data and market landscape analyses to inform their strategies. Below are three essential patient access strategies that brand managers are using to stay ahead of the ever-evolving market landscape.
1. Analyze payer coverage data
Robust data analysis is critical to every copay program. Today, successful brands all use data to inform strategic decisions on their business rules, rebates, and price points. But many brands don’t realize that they’re missing out on pairing copay claims data with payer-level data for their brand. Payer-level data allow brands to look at exactly how specific PBM payers are processing brand claims, helping brands triangulate their coverage estimates versus payer realities.
When looking at coverage rates segmented by each payer, a Truveris client noticed that their coverage rates for a specific PBM were lower than expected, despite their strong drug formulary inclusion. To mitigate this coverage loss, the brand and Truveris partnered to educate the PBM on their missed opportunities in the form of rebates from covered claims. Through analysis of Truveris payer data, the brand also noticed that their prior authorizations were not being processed correctly by a specific payer. The brand worked to resolve this issue by informing their pharmacy networks on correct claims processing and helped better education HCPs and pharmacists on the prior authorization requirements for the drug, helping to increase prior authorization approval rates and turnaround times.
2. Address challenges from copay accumulator and maximizer programs
Copay accumulator and maximizer programs have been rising in prevalence over the past few years. In 2021, 80% of commercial insurance plans offered accumulators and 60% offered maximizers as a benefit option. While PBMs use accumulators and maximizers more frequently to reduce specialty drug spend, they are not required to disclose which drugs they include in these programs. To help pharma manufacturers better understand how these programs work, Truveris has conducted an analysis of whether certain drugs are likely to be included in accumulators or maximizers.
As pharmaceutical manufacturers feel the impact of accumulator and maximizer programs on their businesses, they should strategically evaluate how to ensure their access dollars are going to their target patients. It is essential for pharma brands to partner with a trusted resource that can help navigate the complexities of accumulator and maximizer programs to reach patients and build patient access programs that can be independent and are focused exclusively on their goals.
3. Gain a deeper understanding of employer pharma benefits procurement
Typically, pharma manufacturers have limited visibility into how employers procure their pharmacy benefits. Today, total rewards leaders are confronted with various employee benefits challenges such as increasing prescription costs (especially among specialty drugs) and constantly-evolving regulations. Self-funded plans are also trying to understand how to navigate accumulator and maximizer programs, specialty carve-outs, and the lack of transparency into PBM formulary structures. Employers are looking for innovative ways to bring more benefits to their employees at a lower cost.
By partnering with a patient access partner who deeply understands the employer and payer procurement process, pharma manufacturers can better understand employers’ pharmacy needs and help reshape how commercially-insured employees access their drugs.