How Dynamic Copay Solutions Are Saving Millions, Tackling Maximizers, and Redefining Patient Affordability in Pharma
The pharmaceutical industry is constantly evolving, grappling with rising drug costs, complex patient access challenges, and an increasing demand for cost-effective copay solutions. Copay assistance programs play a critical role in ensuring patients can afford their medications, yet not all solutions are created equal. Innovative copay solution providers have started disrupting this industry, and bring the receipts1 to prove it, saving their clients’ copay programs in excess of $100 million in 2024. The real- word data and solution efficacy behind this result is compelling. So how was it achieved? Let’s first look at the failures that left an opening for true innovation.
Where Legacy Solutions Come Up Short
Traditional copay solution providers often struggle to keep up with the evolving pharmaceutical landscape, having long ago commoditized the service 2 in favor of cultivating their other offerings. This stagnation in copay solutions has led to several key issues:
- Slow response to maximizers and accumulators3–Many providers fail to identify these impacts quickly to optimize savings opportunities.
- Lack of strategic focus–Wide-ranging offerings dilute the effectiveness of copayspecific, targeted solutions.
- Neglect of patient experience–Providers often overlook the increased friction and confusion when applying patient-facing mitigative solutions, leading to reduced adherence.
However, when the challenges of an entire industry are not even recognized, let alone addressed, the opportunity for disruption arises, and is often met by those who innovate technology, solutions, or methods that address an industry’s needs in that moment.
MITIGATING MAXIMIZERS: First-Fill or Bust
One of the most significant challenges for copay program sponsors is addressing maximizers and accumulators that impact more than 40%4 of commercially insured lives as of late 2024. Legacy copay solution providers cannot identify impacted claims on the first fill, and even struggle to mitigate them on the second and third fills, leading to diverted copay assistance dollars and increased out-of-pocket expenses for patients.
A revolutionary approach to this challenge using advanced program design and real-time dynamic business rules was first conceptualized in 2022. This proprietary system was tested out the following year with early adopters in top-10 pharma, and was found to have extremely high accuracy in identifying maximizer impacted claims on the first fill, saving significant amounts of patient assistance funds from being siphoned away by payers and PBMs5. The true test would soon follow in 2024 as wider adoption across major manufacturers, drug classes, dispensing models, and pharmacy types could be analyzed.
MASTERY ACHIEVED: The Results Are Out
With 2024 full-year data analyzed that spanned 66+ retail and specialty pharmaceutical programs, diverse therapeutic classes, and more than 500,000 unique patients, dynamic business rules’ performance results6 are in.
Some key results found include the following:
- 97% accuracy in identifying maximizer-impacted claims on the first fill.
- Dynamic business rules saved $100 million for patient affordability programs in 2024, and over $84 million in Q1 2025 alone, demonstrating unparalleled efficiency in reducing copayrelated costs.
- Partnerships with Top 10 pharma companies show these solutions are now an integral part of major pharmaceutical copay programs.
- Rapid industry expansion and recognition as more pharmaceutical companies acknowledge the necessity of these unique solutions and demand continues to grow.
The dynamic business rules approach is no longer theoretical—it is a triedand-tested success, ready to roll out at scale to the wider industry, actively enhancing and expanding coverage to tackle maximizers head-on.
A New Era of Copay Solutions
Through extensive testing and real world application, bold innovators are setting the new industry standard, identifying areas where the greatest impact can be made, and delivering tangible results for both pharmaceutical program sponsors and patients. Compared to legacy copay models, these solutions offer:
- Faster adaptation to market changes Unlike legacy solutions that rely on outdated methodologies, modern copay strategies are continuously updating and optimizing.
- Customized solutions for pharmaceutical companies Rather than a one-size-fits-all approach, programs are tailored to meet the specific needs of each client.
- Proactive fraud and waste reduction By identifying and mitigating wasteful spending early, resources are allocated efficiently.
The future of copay solutions is about more than just cost reduction for manufacturers. It’s about intelligent, dynamic architecture and program management that help ensure patient affordability programs can continue to be offered, and program sponsors continue to prioritize access and adherence to lifesaving therapies.
