At CBI’s eighth annual Coupon & Copay Forum in October, industry experts gathered virtually to discuss a range of important topics with an audience of pharma leaders and service providers charged with patient access. With 75 companies represented, and 75% attending from life science companies, the conference had a strong cross-section of participation including brand management, market access, reimbursement, patient support, and trade.
As conference chair, I noticed several key themes that emerged from the conversations:
Copay Accumulators Continue to Gain Attention
Because copay accumulator adjustor programs (CAAPs) continue to play an integral role in a pharma brand’s affordability budget and market access strategy, the topic was a popular one. Described differently by insurers that offer them, these programs are gaining traction: As of 2019, approximately a third of employers were using some form of CAAP, with another 19% considering expanding their programs in the next few years. Nearly 6% of patients were impacted in 2018, with that number expected to increase to 8.5% by the end of this year.
COVID’s impact on job loss has created delays in medical care, disruptions in the ability of patients to fill prescriptions, and swings in employer-sponsored healthcare over the past several months. It has prompted employers to look more closely at disparities and equity concerns among employees and as a result, they are recognizing the business value of operationalizing Disability Equity Inclusion (DEI) initiatives. Benefits equity has been a delayed focus, however, and a one-size-fits-all approach may not be good for everyone. For CAAPs, this approach has the potential to exacerbate specialty drug benefit inequities, and a more significant focus on equitable benefit design, particularly for specialty medications, is needed.
Importance of an Access Strategy and How Copay Fits
Copay programming needs to be a key consideration for companies as they evaluate access strategies, including contracting and rebate strategies. Forum participants agreed that if companies are not looking at copay programs in combination with these other strategies, they are making a major strategic error. With rebates, distribution fees, and copay program coupons all linked and impacting overall profitability, now more than ever copay programs must be considered as part of overall patient access strategy.
Financial Responsibility and Benefit Dollars
Financial responsibility is an area everyone in the industry needs to be on top of because of the significant P&L burden of patient benefit dollars. If you’re not watching who you’re buying down and when, buying down blindly as a result is doing a disservice to your shareholders. We’re seeing increased pressure on marketers internally at pharma companies to watch proper offers and economics around the offer.
Among the innovations highlighted during the Forum, virtual copay cards and mobile access stood out. Offering convenience and peace of mind during the pandemic, they help improve the overall patient experience—and companies are seeing a bump in mobile transactions as a result.
Mobile copay is growing, with an uptick in the mobile channel coming at the expense of the physical channel. Patients are able to enroll in programs without a physical card or the need for a laptop or desktop computer. Distribution is also becoming digital, with triggers coming via mobile devices. Currently, traditional physical programs can be slow and error-prone and take up to seven days (from seeking to utilizing a program). With digital, this can be reduced to as short as a few hours.
With up to 80% of patients unaware of patient support programs, underutilization remains prevalent, which is not surprising since patients increasingly prefer digital. Virtual mobile copay cards can help route patients to other resources and serve as a portal to patient access programs. Even older patients undergoing ongoing treatments showed a 10-fold increase in engagement with the case management team after moving to digital.
Developments in Specialty Drugs
Specialty drugs present unique challenges that differ from those faced when launching traditional small-molecule brands, and it can be especially complicated since there are no analogs for certain new therapies. Patient profiles, access, pricing, service needs—everything becomes more complex with complex specialty medications.
In addition, many specialty drugs are brought to market by small companies with lean resources and without the infrastructure to measure and monitor the programs they’re putting in place. How we help alleviate that challenge is going to be critical—especially as the number of novel medications continues to rise. Less than a decade ago, the FDA was approving an average of 23 novel drugs a year; by 2014, that number had climbed to 41 and we’re now averaging 43 approvals a year. With the significant increase in drugs and therapeutic areas, new challenges emerge.
One challenge of benchmarking in novel areas involves segmenting payers and the range of patient support services. If fragmented within an organization, they can be divorced from affordability strategies. Ensuring that these elements are all brought together, understanding key points of insertion and the “net value” of the patient become more important. Working with the right partner to develop a copay program is critical—and often where the wheels fall off. In addition, keeping on top of legislation to ensure compliance while still being able to help patients and understanding buy and bill are key considerations.