At the Asembia Specialty Pharma summit in Las Vegas April 29 – May 2, speakers described a healthcare ecosystem in which specialty products will represent nearly half of all drug spending, while increasing numbers of patients will have to deal with paying for their healthcare out of high deductible health plans (HDHPs). The combination of these two factors – high-priced specialty products and increased patient exposure to these costs – is rapidly creating an unsustainable environment for patients.
With a keen eye on these developments, TrialCard’s evidence-based design of its affordability programs represents a new solution to these persistent challenges. Widely known for its manufacturer co-pay programs, TrialCard has evolved into a digitally-centric company that develops platforms that foster connections with the patient, from the beginning of their journey to therapy completion, ultimately helping drive treatment success.
The need is critical: Medication nonadherence not only severely impacts the individual, but families and employers as well. Recent data demonstrates a particular challenge with adherence in chronic disease states, with the rate for individuals dropping off therapies ranging from 30% to 50%, and more than 20% of new medications unfilled.
As evidenced in studies conducted by the Boston Consulting Group and Cigna, the reasons patients are noncompliant are multi-fold: they forgot to use/refill (24%); the cost of the drug (17%); unwanted side effects (20%); they didn’t feel it’s needed (14%); and they can’t get the prescription (10%).
“There are three core areas that need to be addressed in every affordability and access program we build,” stresses Paul LeVine, VP, analytic services for TrialCard. “The first includes the core administrative functions – such as benefits investigations, prior authorizations, and appeals – that are required to ensure patients can get on product as soon as possible, with as few problems as possible.”
That’s where TrialCard’s “evidence-based program design” comes in. Using this approach, TrialCard leverages its historical experience to understand the practices that have worked in the past, thereby ensuring a higher probability of success moving forward.
“For example, if patients have had issues with prior authorizations getting approved through certain organizations, we will use our knowledge to craft different approaches – where to work that prior authorization hard by gathering additional material we know will help or to recognize that this one’s not going further,” says LeVine. “We can look at different resolutions knowing where there’s an impediment or a hurdle a patient may face.”
For instance, HDHP patients are often trapped by the seasonality factor. Getting through that first fill of the year, through that “donut hole,” is often one of the more significant challenges for patients. Adding to that trauma: Of the top eight charities that have financial assistance programs available for some 190 disease states, on any given day about half of those programs are closed.
The second area focuses on clinical outcomes, reflecting on what additional services – such as nursing, patient education, or injection services – need to be provided to a particular type of patient in order to achieve the desired result. “The overarching concept is to ensure patients get what they need in order to be more adherent and thereby have a better likelihood of a positive outcome,” explains LeVine. All things being equal, a person that is adherent will be a better outcome than a person who isn’t.
Last, but certainly not least, is the economic piece. “How does that patient get the product paid for, how do they afford their treatment?” poses LeVine. “And once they get access for that product, how do they remain on that medication? That’s an ongoing challenge for any type of access program.”
The key is ensuring the right economic solution is coupled with the most effective patient engagement solution. “There are some patients who get on medication quickly once a therapy is prescribed, filling that first script and then continuing on the medication for the duration of their treatment plan. But not all patients follow that path,” LeVine acknowledges.
“A part of what we feel is incumbent upon us – and truthfully, any vendor like us – is to ensure there is a safety net for those patients that fall off treatment,” he adds. “Here again is where our evidence-based program design comes in. We’ve analyzed those ‘negative inflection points’ in the patient journey.”
For example, has the patient proceeded through all the steps in enrolling in the affordability program, but not initiated therapy? Or has that patient had increasing gaps in the time between their refills? “When we see these types of behaviors occurring at the specific times we know matter, we have a golden opportunity to intervene,” notes LeVine.
Though TrialCard is able to provide separate aspects of an access program, it’s when the company has a view into the entire patient that it’s been able to do the most. “When we see patients from the very start, from enrollment through initiation of therapy to ongoing refills, we have the greatest opportunity to help them achieve their most favorable outcomes,” explains LeVine. “And because our approach for patient engagement is to reach patients where they are, we’ll use whatever medium makes the most sense, whether that’s a text, an email, or a phone call.”
TrialCard’s investment in advanced technology and data analytics has allowed it to provide these types of services focused on a deeper understanding of the patient and how they understand treatment experiences.
“We are now able to design and deliver personalized programs and solutions tailored to a patient’s particular set of challenges and motivations,” says LeVine. “Every situation is different, so we think about where we need to focus, based on the patient’s particular situation. It’s complex. It’s crucial for us to get it right.
“There is no one way, no one answer,” he emphasizes. “At TrialCard, we honor the needs of that patient.”