When it comes to designing your copay program, chances are you haven’t considered all of the options. You have a diverse patient population and extending the same offer you’ve used for the past several years, or imitating your competitor’s offering, likely isn’t delivering ideal returns. In a rapidly diversifying coverage environment, the one-size-fits-all benefit designs that worked 2 years ago may not be as effective today.
Patients are shouldering more of the cost for their prescriptions, pharmacy coverage is more complex than ever, and there is significant price uncertainty at the pharmacy counter. When nearly a quarter of U.S. workers are now enrolled in high deductible health plans, it may be time to upgrade your copay program design to one that meets each patient’s needs and applies the appropriate benefit based upon their specific coverage dynamic.
At its most basic, program segmentation can be used to apply a different benefit amount depending on the insurance status of the patient (commercially insured, covered; commercially insured, not covered; cash-only, etc.).
But that’s just the beginning. There are ample opportunities to incorporate segmentation into your copay program to ensure you’re getting the right benefit to the right patient, while capturing the full value of each script. Consider which options may be relevant to your brand’s strategy:
- Deductibles and their impact on patient behavior: Are patients actually abandoning scripts during their deductible phase or is that just a perception based on anecdotal feedback from reps and HCPs? Make sure you understand what’s really happening at the register.
- Days supply and adherence: Are you doing everything you can to drive patient adherence by helping patients fill larger script sizes? Larger pack sizes can create value for all parties in the prescription value chain by reducing patient trips to the pharmacy, driving better outcomes through improved adherence, and creating a more stable revenue stream.
- Electronic pharmacy vouchers and other channels: If your program also leverages electronic pharmacy solutions, how can you ensure your channels are strategically supporting each other versus simply duplicating each other? Are you using each solution and channel like a scalpel or an axe?
- Rebate double dipping and high value scripts: Are you paying the same amount for scripts that are less valuable than others? If so, you might want to adjust your program to give a more generous benefit to scripts that net you more in gross to nets, and incorporate rebates into your overall ROI calculations.
- PAs, NDC blocks, and other restrictions: Does your program have the right design in place to help patients with more complex plans get their script? The right program can help patients and prescribers overcome the headaches of script rejection by offering targeted assistance to patients when they need it, but not indefinitely. This helps patients have access to valuable medications while ensuring profitability in the long run.
- Geography: If you’re adjusting your managed care and rebate strategy in different geographies, why have the same copay card strategy across the country? Your copay card can work in tandem with your managed care strategy to fill gaps in areas with poor coverage and ensure more consistent access and affordability across the country.
Before reusing the same offer from last year, consider the real possibility that you are leaving dollars on the table. Explore the possibilities of segmentation by selecting a unique set of parameters for your drug that will help your program achieve success in this dynamic healthcare landscape.
Questions? Contact us or tweet us @Truveris.
 Kaiser Family Foundation Employer Health Benefits Survey 2015