The opportunity to reshape an industry doesn’t come along every day. Two decades ago copay savings programs were once a novel idea: instant rebate cards that financially assisted millions of patients in accessing vital medications, treatments, and therapies that would otherwise be unaffordable to them. As the technology evolved to utilize the pharmacy claims system, an industry of businesses formed, known today as patient affordability providers. In recent years, many of these providers have come to rely on the steady, predictable – and often hidden1 revenues from these programs, having turned their attention and development dollars to a myriad of other patient-related products. The innovative thinking that spawned the industry has markedly stalled.
The Commercialization of Patient Assistance
Copay solutions have become standardized across the patient affordability industry with no major differentiating features, leaving them highly commodified. With many patient affordability providers using copay processing as a primary source of profit to cultivate their other offerings, it becomes difficult to respond to changes within the pharmaceutical copay landscape. The vigorous spread of copay accumulators and maximizers2 has had a costly impact on drug manufacturers, the primary sponsors of copay savings programs. Accumulators and maximizers have become financial barriers, as PBMs and payers use these practices to divert the manufacturer-sponsored funds of copay savings programs away from the patient to instead increase their own bottom lines.
Instant rebate cards that financially assisted millions of patients in accessing vital medications, treatments, and therapies that would otherwise be unaffordable to them.
After more than a decade of hands-on experience in patient affordability, I’ve often been asked about the state of this industry. I work with many pharmaceutical companies sponsoring copay programs and have come to recognize that their concerns were being ignored – and in some cases there were larger issues to uncover.
Reshaping a Legacy Industry
After considerable time with no major advancements, the industry is at a tipping point that will favor progress. Accumulators and maximizers continue to have major impacts on the manufacturers sponsoring programs and, ultimately, the legacy copay savings solutions that make up the majority of active programs are now decidedly outmoded as they fail to address their clients’ needs. My contemporaries in the industry also noticed this lack of progress.
It is time to rethink how copay programs are engineered and return to the inventive approach where they got their start, but with deeper industry expertise and modern business intelligence. A renewed interest in improving copay technologies and finding the next big leap also means program sponsors will return more of their focus and resources to innovations and advancements of their own – as long as they have the right provider.
Program sponsors should seek and select a vendor with agile, adaptive technologies that will signal the copay industry is back to a cycle of innovation and breaking new ground.
Solving the Patient Affordability Puzzle
Cracking the code on patient affordability’s biggest issues may seem impossible but can be achieved through dedicated, cooperative partnerships. Program sponsors should seek and select a vendor with agile, adaptive technologies that will signal the copay industry is back to a cycle of innovation and breaking new ground.
Traditional copay savings programs need to be rebuilt from scratch on a modern fintech foundation. And more importantly, progress in the industry will come from vendors who focus solely on patient affordability programs and solutions with their team and resources dedicated to delivering:
- Innovation, development, and integration
- Copay accumulator and maximizer mitigation
- Fair and transparent pricing practices
- Seamless program transitions
- Enhanced medical benefit copay programs with unmatched processing times
- Healthcare insights paired with fintech functionality
- Actionable business intelligence
Finally, the successful patient affordability innovator will be a steward of good pricing practices, helping to drive pricing transparency across the healthcare industry. As a committed partner to the pharmaceutical industry they will not prioritize profit to the detriment of access, adherence, and positive patient outcomes.
