More research needed to quantify the impact of copay cards

There is also a perception that there is incomplete information and a lack of transparency into copay offset programs, a deficit of information that a newly released market research study conducted by The Zitter Group, the Copay Offset Monitor (COM) aims to address.

COM collects information on the benefit design of more than 400 copay programs representing both small molecule and biologic brands. Seventy-seven percent of biologic brands currently have a copay program compared to 44% of small molecule brands. The greater density in biologics indicates an initiative to reduce patient out-of-pocket cost for expensive treatments. Mean per fill benefit amounts and ranges are higher in exemplary biologics than in small-molecule therapeutic categories.

Program duration

Diabetes programs exhibit a mean per fill benefit amount of $90 within a range of $25 to $250. Therapeutic oncology programs exhibit a mean per fill benefit amount of $196 within a range of $20 to $417. Sixty-five percent of copay programs are valid for multiple prescriptions allowing patients to save over a longer period of time. Of these, about 60% are set to expire at the end of 2012, about 10% at the end of first quarter 2013, and about 10% at the end of 2013. This suggests that the majority of programs for multiple prescriptions are good for at least 1 year.

COM also includes market research on key groups whose perceptions and behaviors drive trends in the copay offset program landscape: physicians, patients, pharmacists, brand marketers and payers. The report was designed to address the information needs of brand marketers responsible for copay offset programs, and can be used to optimize copay offset program design through benchmarking against other programs and more rapid awareness of innovations in program design.

Primary market research on stakeholder groups allows marketers to better understand how copay offset programs are used and what works best from an operational perspective. COM also includes script transaction data from pharmacy partners, allowing marketers to determine utilization and copay dollars offset by their brands’ program relative to competitors.

COM provides secondary research into the copay program, copay vendor and copay market share landscape. COM conducts primary research of about 400 physicians, 300 patients, 50 pharmacists, 50 copay program marketers, several copay program vendors and select payers. COM also integrates data inputs from copay program vendors, pharmacies and copay program experts.

Varied Program Goals

While the well-publicized Lipitor program created the impression that retaining market share for a brand that has gone generic is a primary motivation for copay offset programs, only 3% of brands with copay offset programs face direct generic competition. More copay offset programs are directed at defending against in-category generics and matching the offers of other branded products.

Overcoming disadvantaged formulary placement, improving initial fill rates, reducing prescription abandonment and increasing compliance are other motivations. Copay offset programs also provide a talking point for manufacturers’ representatives to engage physicians and a focal point of patient relationships, facilitating communication and collection of market research information.

The figures depict copay offset program benefit designs in 2 drug categories which include innovative designs suggesting varied program motivations. For example, programs in the hypertension category might have a “pay only” structure, that is, programs that reduce patients’ copays to a set dollar amount. For Daiichi-Sankyo’s program, the patients’ copay responsibility is progressively lowered after six and 12 months of use. This benefit structure incentivizes the patient to stick with therapy and relays the message to physicians that the manufacturer appreciates the importance of compliance to positive patient outcomes.

There is a different dynamic in the rheumatoid arthritis category. Brands such as Cimzia offer more generous benefits for the first fills, combating the sticker shock associated with initial trial of a biologic therapy and providing an opportunity for the patient and the physician to access the benefits of the therapy for the patient.

Script Level Data

Of course, the real impact of a copay offset program depends on program utilization as well as benefit design. COM monitors the competitive standing of copay offset programs based on program utilization driven from pharmacy script data.

Attitudes and Behavior

The impact of a copay offset program also depends on the experiences of the physicians, medical practice staff, patients and pharmacists who engage with it. Pilot surveys of patients and physicians who had used copay offset programs or provided patients with copay cards suggest that many physicians and patients have favorable opinions of copay offset programs, expressing that they enhance uptake of newly prescribed therapies and adherence. A pilot study of rheumatoid patients found that almost 70% of patients surveyed agreed or strongly agreed that a copay program has helped them be more adherent in taking their medications.

Despite these positive perceptions, many physicians do not distribute copay cards or recommend copay coupons to all patients who qualify. Among a sample of 202 physicians consisting of 102 general practitioners and 100 endocrinologists treating diabetes patients, 56% said that they always provided copay cards or recommended copay offset programs when available, whereas 32% offered copay cards or information about copay offset programs only in response to patient financial difficulty.

If a substantial minority of physicians act as gatekeepers for copay program access in this way, it may undermine claims that copay offset programs directed to non-specialty products do nothing to help financially needy patients.

As the sophistication and controversy increases, copay programs become a critical piece of manufacturer marketing strategy. Historically, the industry has suffered from a lack of comprehensive information on extant copay offset programs, as well as a lack of actionable market research on the behavior of the main stakeholders. This has led to guesswork in benefit design and confusion among the groups-brand marketers, payers, pharmacy benefit managers, patients, and physicians-impacted by copay offset programs. Insight into stakeholder behavior and perceptions to identify the best design and optimize distribution of copay programs increases patient uptake and adherence. COM aims to enhance transparency and the availability of reliable and regularly updated information on the copay offset program environment. 

Future research is required to determine actual impact of copay offset programs on total cost and quality of care across the payer access and regulatory landscape.  

Chris Wheeler is the director of copay strategies for The Zitter Group, and can be reached at cwheeler@zitter.com, 202.660.2934. Bryan Conner and Sarah Veeck are analysts for The Zitter Group.