Copay Adjustment Programs: What Brand and Hub Teams Need to Know

The advent of accumulator and maximizer programs represents yet another hurdle for patients to gain access to their specialty medication. When evaluating the brand strategy needed to mitigate their impact on patients, pharma brand teams and hub program managers should focus on factors specific to their therapeutic area, brand, and program.

First, consider how many of the brand’s patients are subject to accumulators and maximizers. More importantly, what is the percentage of patient benefit spend that those patients represent? Based on ConnectiveRx data, while it may typically represent 10 to 15% of the total patient population, often as much as 40% or more of the overall benefit spend in an annual period is going toward that 10 to 15%.

One advantage of traditional copay programs was that because these programs serve as a secondary insurer, patients didn’t have to be involved. A pharmacist could go directly to a brand website to access an offer, or an HCP could find an offer when prescribing a medication and then send it to the pharmacy on behalf of the patient.

The Importance of Holistic Approach in Copay Adjustment Programs

However, in order to mitigate against copay adjustment programs, it is important to know who your patients are and how to contact them, which requires a more traditional enrollment, such as a hub enrollment. This introduces an inherent conflict in strategy: program access vs. benefit spend. The access to traditional copay outlined above (i.e., the patient may not even need to be involved) no longer applies if a brand team wants to successfully mitigate against copay adjustment programs. To ensure all parties understand the tradeoffs and interconnected relationships of how the program will operate moving forward, it’s important for pharma teams to approach the solution holistically with everyone at the table, including representatives from finance, procurement, access, and brand strategy.

Putting patients front and center should be a key component of your plan, and it is important to recognize that your patients most likely do not understand copay adjustment programs and how they’re impacted by them. A ConnectiveRx survey of 115 patients who received calls from their primary insurance provider revealed that 61% had no knowledge of accumulator adjustment programs. The results also showed that payers are calling patients multiple times – potentially after every script fill – to inquire about how patients are paying for their medication.

You want to improve brand loyalty on the part of patients by removing the disruption described above and communicate with them strategically. Using simple, targeted, and effective messages at the point where the patient is impacted allows you to educate them about what these programs mean and what the brand is doing on their behalf. This can make frustrated, confused patients feel more comfortable, and they will appreciate the helpful, educational approach, which translates over time to increased brand loyalty.

HCPs Misunderstanding of Copay Adjustment Programs can Impact Patient Care

ConnectiveRx data points to a lack of knowledge and understanding of copay adjustment programs among HCPs as well. In a survey of 200 HCPs, only 23% chose the correct definition of a copay accumulator adjustment program. More surprisingly, the largest number of respondents, 39%, incorrectly chose “a tool used by manufacturers to track a patient’s cumulative use of copay assistance over time to ensure that annual maximum benefit limits are not exceeded” to describe them.

Considering the critical, consultative role HCPs play in a patient’s healthcare journey – including referring them to copay programs – the fact that they believe an accumulator is a helpful tool for patients is concerning.

Similarly, when asked to choose the correct definition of copay maximizer programs, most HCPs (40%) chose essentially the opposite of what they actually are, identifying them as “a software program used by pharmacies to search for and tag the most generous copay support programs for a specific product in an effort to provide maximum financial support to patients.”

Developing a Successful Strategy to Counteract the Impact of Accumulator and Maximizer Programs

HCPs’ lack of understanding of these programs can lead to incorrect guidance given at the point of care that then becomes a burden for hub program managers to overcome in educating patients. Once a strategy has been put in place to mitigate the impact of accumulators and maximizers, data capture and reporting can help measure the effect that strategy is having on patient access and adherence. What you can measure you can manage, so identifying up front the program goals and desired insights is crucial to program success. Further, defining those key performance indicators in advance allows brand teams to make data-driven decisions on how to tweak mitigation strategies over time, which is needed as copay adjustment programs continue to evolve.

When developing a strategy to mitigate the impact of accumulator and maximizer programs, pharma brand and hub teams should consider the key factors outlined above. Bringing together the right people to develop a thorough understanding of which patients are impacted and the financial impact the programs will have, undertaking proactive patient and HCP education, and leveraging hub program data can together help reduce the impact of these programs and ultimately improve patient access and adherence.