As the burden of patient spending on medications continues to increase, the need for co-pay assistance programs that enable patients to afford their medications has never been greater. However, price is only one of many factors that can prevent a patient from filling his or her prescriptions, and it may be possible for co-pay assistance programs and their associated ancillary services to address other access, adherence, and reach issues.

Speaking at the Formulary, Co-Pay, and Access Summit, held April 11 and 12 in San Francisco, Paul LeVine, VP for analytic services at TrialCard, highlighted ways in which co-pay programs and ancillary services can go beyond addressing the price of medications.

During his presentation, entitled “Operationalizing the Engagement Channel — Tactical Best Practices for Access, Adherence, and Reach,” LeVine (right) emphasized that poor medication adherence rates are responsible for driving up claims costs for payers, and that this problem has remained intractable despite co-pay assistance programs making medications more accessible to patients.

Perhaps surprisingly, according to LeVine, cost “isn’t the most important factor for adherence; it’s not even second or third.” As a result, co-pay assistance programs and their associated ancillary services “must think about fitting [adherence and engagement] interventions to patient needs, and not just target cost.”

“Adherence is inherently baffling,” he opined. “All the solutions work to some degree, but you never get enough individual people into a solution to move the needle, to see the effect on the population level.”

Hiding in plain sight

“What’s really going on with these programs is that they’re acting as acquisition vehicles for patients,” he added. “Indeed, we see these programs as representing an “Affordability and Engagement Channel” to be leveraged. And that’s something that holds enormous potential for addressing many other issues that our clients face. Look, we all live in our own worlds, where we think that the only thing that matters is reducing a patient’s co-pay. That’s real and vital and core – but there’s much more that they can do.”  

According to LeVine, co-pay assistance card and coupon programs are a perfect vehicle for engagement, as these tools are used by as many as 10% of patients who are not insured by government-funded programs, usage rates that dwarf typical rates reported by adherence-only programs.  

“I’ve been speaking at these conferences for years now, but it’s been only in the past couple that I’ve started hearing people talk more about patient engagement.” LeVine continued by emphasizing, “Engagement is essential to co-pay.”

LeVine noted that, in a study conducted by Judith Hibbard at the University of Oregon, patients who were the most engaged with their healthcare had claims costs that were as much as 20% lower than those for patients who were less engaged.

“The beauty of it is that these programs are also well liked,” he said. According to a Zitter Health study cited by LeVine, as many as 70% of pharmacists and 73% of physicians report that they always recommend co-pay offset programs to their patients if they’re aware of them.

“You have something that people are using and that medical professionals are encouraging patients to use,” noted LeVine. “This is a real advantage.”

Medication reminder services

To highlight how co-pay assistance programs and their associated ancillary services can meaningfully improve access and adherence, LeVine described how a unique adherence initiative run by TrialCard associated with a co-pay assistance program was able to meaningfully improve access and adherence for one of the top 20 medications in the country. It did so by addressing the so-called “first-fill problem,” one manifestation of which occurs when a patient activates a co-pay card, but never goes on to make use of it at the pharmacy counter.

“We all think the problem with adherence is getting from 3.5 fills to 4.5 fills. It isn’t so,” said LeVine. “The problem with adherence is that first fill. If you can’t get that first fill, you don’t get the fourth fill. And this requires patient engagement.”

In the pilot LeVine described, patients were monitored for whether they used the copay card within five days of activating it. “Over the course of four years, only about 20% of patients would use the card for the first time if they waited more than five days after activating it. But when we instituted this initiative the figure rose to 34.5%.”

A data-driven approach

Although LeVine found this improvement to 34.5% impressive, he suggested that further optimization is still possible.

“[This improvement in first-fill rate] represents a lot of money, but there is more to be done here, because this was done without any of the behavioral screening that you can include in a program such as this,” he explained. “This is brute force. This is simply reminding them X number of times through whatever mediums are available to please, redeem.”

LeVine suggested that more sophisticated, behavioral data-driven approaches could further improve adherence while driving down costs beyond what this pilot study was able to achieve.

Sales force support

Patients are not the only group whose engagement can be improved through co-pay assistance program ancillary services. In a second case study, LeVine highlighted the powerful tele-promotion effectiveness of calls placed to physicians and pharmacies made to educate them about the existence of co-pay assistance programs for a popular respiratory medication.

According to LeVine, finding new tactics for reaching healthcare providers in support of drug sales is key — as many as 56% of physicians now refuse to see drug-manufacturer representatives in their offices. Sales force support calling campaigns represent one such strategy.

In the case study highlighted by LeVine, sales force support calls to healthcare provider offices and pharmacies both significantly boosted prescription fill rates. Calling healthcare providers or pharmacies alone was also effective, but the best prescription fill results were obtained when outreach was done to both. Notably, repeat calls to pharmacies offered far better results than single calls, presumably because calling at different times reached different pharmacy employees.

High-cost specialty product access

As has been noted previously, spending on high-cost specialty medications has been rising rapidly. Both QuintilesIMS and have estimated that the percentage of total drug spend on specialty medications will reach about 44% by 2020.

And of course, the access problem for these high-cost, specialty products is different. “Hub programs that support these products require much more intensive investigation of benefits and eligibility, which often are very manual,” said LeVine. “You hire people and often lots of people.”  

But LeVine described the approach TrialCard has used to create a more software-based solution.

“With the help of a key technology partner, we have managed to significantly reduce the cost of these programs by leveraging the use of these automated solutions,” he said. “It’s not a total solution yet, but it keeps improving and we anticipate that greater and greater numbers of these activities [benefit investigations, prior authorizations] will be handled in an automated fashion within the next year or two.”  

The affordability and engagement channel – driven by co-pay

Taken together, LeVine suggested these results demonstrate that the affordability channel goes beyond co-pay.

“There are other parties that can be engaged,” he concluded. “And the opportunity to engage – not only your patients – but prescribers and pharmacies as well, is tremendously valuable because of this channel. We just have to start thinking about it differently.”

This article was curated by the MM&M Content Lab, on behalf of TrialCard.