In light of this, what can brands do to grow their profitability and market share, while supporting patient adherence and maintaining their first-choice status among HCPs? Is it wise to focus solely on the fight against expanding PA requirements, or can there be another way to combat the issue simultaneously?<\/p>\n
Electronic Prior Authorization Helps Speed PA Responses<\/h3>\n
For many patients, providers, and brands, a significant improvement in adherence can be attributed to the increasingly widespread use of electronic Prior Authorization (ePA). Whereas it could take weeks to receive a response to traditional PAs, ePAs can be determined in just a few minutes when requirements are submitted quickly and the decision is straightforward.<\/p>\n
The challenge, however, arises when approval is not a simple matter. The retrospective ePA process, which triggers the need for a PA upon denial at the pharmacy, all too often leaves patients, pharmacists, and prescribers stuck in a sort of limbo due to uncertainty a PA is even being requested. Any administrative delay in the process\u2014prescriber being unaware that a PA is needed, the pharmacy not knowing a PA is being pursued, the patient seeing the full cost of the medication\u2014may leave the patient with no choice but to walk away without their prescription. In other words, the increasing implementation of the ePA process certainly helps, but it is not enough to solve the PA dilemma.<\/p>\n
So when brands are challenged with the task of supporting patient adherence while also maintaining profitability and market share, the answer may lie in finding innovative ways to use the ePA system to ensure patients leave the pharmacy with their medication in-hand. Recent case studies conducted by ConnectiveRx point to a comprehensive prescription first fill buy-down copay program built into the ePA process as a potential solution to this growing problem.<\/p>\n
Prevent Patients from Leaving the Pharmacy Empty-Handed<\/h3>\n
It is widely understood that patient savings programs greatly increase access and adherence for branded and specialty medications. In fact, recent market research shows an 11.5% script lift when patient savings options are offered.2<\/sup><\/p>\n However, most savings programs are generally available for approved medications, not pending ones. If brands offered to buy down the first fill of a medication before approval is received, the approval process could play out behind the scenes while patients are sent home with their medications. Such a program gives prescribers the time they need from an administrative perspective to provide adequate information to the payers to help secure approvals. If the process results in approval, the brand will be reimbursed for the first fill buy-down cost by the health insurer, and patients are more likely to refill and adhere to their medication, resulting in continued revenue for the brand.<\/p>\n Speaking of administrative burdens, this in itself is a major hurdle for HCPs and their staff. In fact, 64% of providers report altering their choice of brands due to access challenges, including PA.3<\/sup> Additionally, if they believe brands are only offering copay cards after a medication is approved, there is little motivation for them to suggest their first choice when the risk of prescription abandonment is so high.<\/p>\n A program such as this is not without its risks. What happens, for instance, if a payer denies the PA regardless of everyone\u2019s best efforts? A proper risk assessment analysis would help mitigate fears around buy-downs before approval and highlight success rates against inevitable denials. It is therefore imperative that brands acquire adequate data for each buy-down. Data transparency around approval and activity rates by prescription, pharmacy, geography, and payer are vital to ensuring a comprehensive understanding of the success of this program. Brands tracking activity and approval rates by prescriber can leverage this insight for more effective commercialization efforts.<\/p>\n In the aforementioned case studies, ConnectiveRx did exactly this: Tracked ePA initiation status in order to determine cost vs. revenue. One brand (Brand X) offered a copay program which covered the cost of first fills while patients were awaiting PA decisions from their health insurers. Of those, 7,597 refills were subsequently covered as the PAs were approved. Brand X paid out an average of $606 for the buy down but just $196 for the refills. All told, the buy down program cost Brand X just short of $1.5M altogether; however, they earned more than $4.6M from payers, resulting in a revenue stream of more than $3M on refills alone (see Figure 1).4<\/sup><\/p>\n These trends in PA are not going away\u2014almost all new brand launches are for specialty medications, after all\u2014so brands should consider innovative, outside-of-the-box thinking that focuses on the big picture around revenue for the life of the script. Remember, the most important factors for overall patient health and brand revenue is to ensure patients are walking out of the pharmacy with their prescriptions in hand. Providing adequate time that allows the administrative hurdle to be overcome while the patient immediately initiates therapy is a reasonable path forward if you know your data and target opportunity well.<\/p>\nMitigate Risks Around First Fill Buy-Down Programs<\/h3>\n
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<\/a>The Bottom Line<\/h3>\n