Prescription co-pay assistance from pharmaceutical manufacturers isn’t a new concept. Manufacturers like you have been offering co-pay assistance for years to patients who need support with the cost of their medications. What’s new is the electronic part. Now, thanks to technology, patients at pharmacy counters can find out in a matter of seconds whether they qualify for financial assistance that reduces their out-of-pocket costs.

By completing this process at the point of dispense, electronic co-pay assistance offers a more streamlined way to help your pharmaceutical company - and patients - realize the full benefits of your co-pay assistance programs.

Challenges of paper-based co-pay assistance

Traditionally, co-pay assistance was issued in the form of paper coupon cards. Pharmaceutical manufacturers gave out cards to sales personnel. These representatives then distributed the cards to physicians and talked about the clinical benefits of the medications.

In today’s electronic world, this approach doesn’t maximize return on investment. You’re responsible for the cost of producing the paper coupon cards and the time spent by sales personnel handing them out. Plus, physicians may not retain coupon cards or forget to give them to patients. Patients, if they did get coupon cards, may forget to bring them to the pharmacy. And the pharmacy may be unable to help patients who forgot their cards.

At the end of this experience, there’s a good chance that even a beneficial, prescribed and accessible drug will stay on the shelf because the patient can’t afford it. The patient is frustrated. The physician is frustrated. The pharmacy is frustrated. You’re frustrated. Manufacturers estimate that patients use 20 percent of paper coupon cards to purchase medications. I think it’s closer to 10 percent or less.

Electronic co-pay assistance in five steps

The solution to this challenge is using technology. Through technology, you can create a seamless transaction that ensures a patient gets the medication he or she needs. Here’s how it works:

  • Step 1: You determine the financial parameters of the co-pay assistance to be offered for a specific medication.
  • Step 2: You relay the co-pay assistance parameters to a third-party vendor. The vendor aggregates that information with the co-pay assistance parameters for other medications from other pharmaceutical manufacturers.
  • Step 3: The vendor integrates that information with the pharmacy management systems used by pharmacies across the country.
  • Step 4: When a pharmacy receives a prescription, it submits the drug claim for payment to the patient’s health plan.
  • Step 5: Based on the patient’s prescription drug benefits and the financial parameters of the co-pay assistance, the system automatically applies the available financial assistance at the point of dispense and sale to the patient.

This happens in real time. It’s a split-second process that doesn’t add to the pharmacy workflow or disrupt the pharmacist’s work. Your co-pay assistance terms appear in the pharmacy management system on the screen. The pharmacist informs the patient. And then the prescription is filled and the transaction is completed.

The benefits of electronic co-pay assistance

As a pharmaceutical company, electronic co-pay assistance programs benefit you in four ways:

  • Drug formularies. Co-pay assistance programs reduce the need to have new medications included on health plans’ and pharmacy benefit managers’ approved drug formularies in order to make the medications affordable for patients.
  • Patient acquisition. Programs help with new patient acquisition. For instance, patients who are prescribed high-cost specialty drugs for the first time will be able to afford to get their prescriptions filled and start treatment.
  • Medication adherence. Programs help patients stay on their prescription drug therapy longer because it’s more affordable. That continued adherence generates continued sales and better health outcomes.
  • Brand reputation. Programs help enhance the perception and reputation of your brand in the marketplace. Prescribers and patients are more likely to use medications that are affordable.

In order to receive those benefits, you must take a strategic and sophisticated approach to your co-pay assistance programs. Just going electronic isn’t enough. You need to personalize your programs so they target specific groups of patients.

Optimizing Co-Pay Assistance Programs to Improve Medication Adherence Photo

A targeted approach to co-pay assistance

You can optimize co-pay programs by tailoring the assistance you’re willing to offer each patient. That’s more granular than giving all patients the same terms regardless of their prescription drug benefits or how much they can pay. That blanket approach is another drawback to the paper coupon card method.

For example, electronic co-pay assistance programs can set parameters that:

  • Limit assistance to patients who are new to a specific drug therapy. By offering financial help only to first-time users of the drug therapy, you can reduce first-time abandonment rates for high-cost specialty drugs.
  • Bar co-pay assistance to patients who have been on a specific drug regimen for months if not years. The patients have demonstrated the ability to afford their medications themselves or through their health plans.
  • Limit the number of refills eligible for co-pay assistance. The patient may have the means to pay for their prescriptions and shouldn’t be given an ongoing discount that comes at the expense of drug sales revenue.
  • Offer co-pay assistance to patients with high-deductible health plans only until the patients’ deductibles are met and their prescription drug benefits kick in. In this instance, you’re helping patients when they need it most.

This targeted approach is made possible by the analytics in the co-pay assistance technology. By using these capabilities, you can identify individual patients, their health plans, their prescription drug benefits, their deductibles and their medications. You can then determine the precise level of financial assistance that drives medication adherence yet maintains and builds business for your pharmaceutical company.

When you take this approach to co-pay assistance, you should measure its success by tracking three KPIs for each medication: prescription abandonment rate, days of therapy and sales. By comparing data before and after co-payment assistance is offered, you can know if the level of assistance is right for a specific drug and the patients prescribed to take it.

If done right, the abandonment rate will drop and the days of therapy will increase. So, too, will the health status of patients and the satisfaction of prescribers and pharmacies.

Related: Learn more about McKesson’s patient co-pay assistance programs for pharmaceutical manufacturers

Megan Wetzel

About the author

Megan Wetzel is a Product Manager for RelayHealth Pharmacy Solutions. She has over five years of experience with the company in both project management and product management positions. In her current product management role, Megan drives innovation for the technical and business facets of eVoucherRx, RelayHealth's paperless co-pay assistance solution for patient adherence.

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