Co-pay Accumulator Programs: Oncology Manufacturer Strategies & Tactics for Ensuring Patient Access

STUDY OVERVIEW

Payers and Pharmacy Benefit Managers (PBMs) have turned to co-pay accumulators - and other like-minded programs with different names - to counter rising pharmaceutical costs. Payers are using these programs to block traditional forms of manufacturer-sponsored financial assistance for therapies, such as co-pay coupons. The result has been patients paying more out-of-pockets costs, and switching to generics or other lower cost therapies.

Best Practices®, LLC conducted this study to highlight the tactics and strategies that oncology and other specialty manufacturers are using to counter “co-pay accumulator” (CA) programs. The study also looks at how oncology and other pharma organizations are measuring the success of their CA mitigation strategies and working with patients to ease out-of-pocket costs. Market access leaders in oncology can use this research to create and deploy effective CA mitigation strategies and ensure patient-centric treatment and reimbursement solutions.

Topics addressed in this study include:

• Copay accumulator mitigation tactics and strategies
• Financial assistance as a percentage of overall product revenue
• Copay accumulator mitigation strategy KPIs
• Challenges and key lessons learned in implementing copay accumulator mitigation strategy
• Best practices and lessons learned in ensuring a positive patient experience

• Co-pay Accumulator Mitigation Program: Strategy & Tactics Used
• Evaluating Operational Challenges, Program Success, and Lessons Learned
• Creating a Seamless Patient Experience
  

• Importance of each of the listed objectives in the organization’s strategy for mitigating the impact of copay accumulator programs
• Effective tactics for countering copay accumulators on both macro and micro levels
• Effectiveness of each of the listed steps for mitigating the negative effects of copay accumulator programs
• Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies using prepaid debit cards
• Cons and risks of using prepaid debit cards, benchmark usage data
• Effectiveness of copay accumulator mitigation tactics
• Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies planning to use prepaid debit cards
• Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies not using prepaid debit cards
• Use of new forms of copayment
• Types of non-coupon copayment approaches
• Percentage of total product revenue allocated by benchmarked organizations to all forms of financial assistance currently
• Percentage of total product revenue allocated by benchmarked organizations to financial assistance immediately prior to the existence of copay accumulators
• Average increase in financial assistance outlays - OOPC minimizers vs. Manufacturers with no OOPC progress
• Interview narrative around the approach to tackle the challenge of growing financial assistance costs
• Interview narrative around copay vendor support
• Additional copay accumulator mitigation tactics or activities conducted by benchmarked organizations
• Main discussion points and outcomes of direct payer interactions for organizations that directly meet payer groups to address access-to-care challenges or negotiate new payment terms related to copay accumulator programs

• Despite fewer generics, oncology may be at even greater risk from CAs than the rest of specialty manufacturing.

• Nearly all of oncology manufacturers (88%) indicate increased OOP costs for their cancer patients. Despite the seriousness of the condition, a wide number of cancer patients may be willing to flee from incumbent products to alternatives with better OOP protections available.
• Oncology firms are also more likely than other specialty drug makers to have observed a higher number of patients affected by CAs, gathered more complaints about them, read more negative press, and measured more product abandonment.

Best Practices, LLC engaged 25 Market Access and Patient Support executives from 21 specialty biopharma companies. This research includes, quantitative data from 25 survey responses and qualitative insights from 9 deep-dive interviews. This study also includes separate data from 8 oncology manufacturers.

If you purchase Best Practice Database document(s), you will have 30 days from the date of purchase to apply some or all of the cost of the document(s) toward the cost of a Full Access Individual, Pharma, Group or University Membership. Write us at DatabaseTeam@bestpracticesllc.com or call David Guinn at 919-767-9179 if you have any questions.