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Products & Services Managed Care Patient-Centered Managed Care

Meeting the Challenge of Copay Accumulator Programs: Effective Oncology Manufacturer Strategies & Tactics for Ensuring Patient Access

ID: PSM-361


Features:

24 Info Graphics

46 Data Graphics

990+ Metrics

64 Narratives


Pages: 80


Published: 2019


Delivery Format: Shipped


 

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919-403-0251

  • STUDY OVERVIEW
  • BENCHMARK CLASS
  • STUDY SNAPSHOT
  • KEY FINDINGS
  • VIEW TOC AND LIST OF EXHIBITS
The introduction of copay accumulator programs by some pharmacy benefit managers (PBMs) and payers has resulted in increased out-of-pocket (OOP) costs for patients, posing a major threat to certain expensive specialty treatments such as oncology. To meet the challenges posed by copay accumulator programs, oncology specialty pharma manufacturers are taking rapid steps to ensure both patient access to medicine and ongoing adherence.

Best Practices, LLC conducted this benchmarking research to highlight the impact of payer-imposed “copay accumulator” programs on oncology and other specialty manufacturers and their patients. This report also looks at the effective tactics and strategies employed by specialty biopharma companies for mitigating the impact of copay accumulator programs.

Specifically, the report provides benchmarks and insights around copay accumulator threat assessment, leading and lagging indicators of copay accumulator impact, decision triggers to counteract copay accumulators, effective copay accumulator mitigation strategies and tactics, use of new forms of copayment, types of non-coupon copayment approaches, financial assistance outlays, and key performance indicators to measure the effectiveness of copay accumulator mitigation strategies.

The report also highlights the success factors, operational hurdles and lessons learned in implementing an effective copay accumulator mitigation strategy.

Oncology Market Access and Reimbursement leaders can use to this research to create and deploy an effective copay accumulator mitigation strategy that meets the full scope of the threat and ensures patient-centric treatment and reimbursement solutions.

Industries Profiled:
Biopharmaceutical; Pharmaceutical


Companies Profiled:
Specialty Biopharma Companies

Study Snapshot

Best Practices, LLC engaged 25 Market Access and Patient Support executives from 21 oncology and other specialty biopharma companies in this research through a benchmarking survey. Nine benchmark partners were further engaged in deep-dive interviews to gain additional insights. Nearly 90% of the benchmark partners serve at the director level or above.

Insights in this research are presented in three segments:

  • Total Benchmark Class: Data based on survey responses originating from all 25 manufacturers in this study (abbreviated as “TBC”).
  • Oncology Segment: Data based on survey responses from 8 oncology product manufacturers.
  • Out-of-Pocket (OOP) Costs Minimizers: Data based on survey responses from 7 manufacturers who have reported success in minimizing patient OOP costs, the top-rated objective of copay accumulator mitigation strategies across the industry.

Key topics covered in this report include:

  • Copay accumulator threat assessment
  • Key market triggers and decision points considered for counteracting copay accumulator threats
  • Copay accumulator mitigation tactics and strategies
  • Financial assistance as a percentage of overall product revenue
  • KPIs used for copay accumulator mitigation strategies
  • Challenges and lessons learned in implementing copay accumulator mitigation strategies
  • Best practices and lessons learned in ensuring a seamless patient experience
  • Future market access challenges and potential mitigation tactics


Key Findings

Select key insights uncovered from this report are noted below. Detailed findings are available in the full report.

  • Significant threat: Specialty drug makers view copay accumulators (CAs) and copay maximizers as a significant threat to their current business.

    • On a scale from 1 to 5 (where 1 = “no threat,” 3 = “minor threat” and 5 = “major threat”), benchmark companies rate CAs 3.6 out of 5.0. Oncology firms rate CAs a 3.3 out of 5.0.

  • Creative patient-centric reimbursement solutions needed: Prepare to adopt creative, flexible solutions for identifying impacted patients and providing necessary reimbursement help.

    • The most pressing operation hurdle – cited as “significant” by 50% of oncology manufacturers – involves adequate communications with patients around the use of the new kinds of financial assistance they may need. A related hurdle cited involves the added complexity of manufacturing organizations pharma relying on copay vendors who may administer these new payment solutions.
Table of Contents

I.
Executive Summary
Research Overviewpg. 3
Key Findingspg. 6
II.
Full Study Data
Quantifying the Copay Accumulator Threatpg. 13
Key Indicators of Copay Accumulator Impact on Specialty Productspg. 20
Copay Accumulator Mitigation Program: Strategy & Tactics Usedpg. 32
Evaluating Operational Challenges, Program Success, and Lessons Learnedpg. 57
Creating a Seamless Patient Experiencepg. 67
Future Threats and Market Access Challengespg. 73
III.
About Best Practices, LLCpg. 80

    List of Charts & Exhibits

    I. Quantifying the Copay Accumulator Threat

    • Characterizing the severity of the threat posed by copay accumulator programs (and related programs like copay maximizers) to benchmarked organizations and the pharmaceutical manufacturing industry on the whole - Total benchmark class and Oncology segment
    • Success rating of benchmarked companies’ copay accumulator mitigation strategy thus far - Total benchmark class and Oncology segment
    • Leading and lagging indicators of copay accumulators
    • Average percentage of specialty products currently affected by copay accumulators
    • Approximate percentage of total commercial channel product volume subjected to co-pay accumulator programs - Total benchmark class and Oncology segment
    • Market access leaders’ approach toward altering their copay accumulator mitigation strategies as legislative developments come into effect from Jan. 1, 2020

    II. Key Indicators of Copay Accumulator Impact on Specialty Products

    • Leading indicators of copay accumulator impact and trigger for taking action
    • Leading indicators of copay accumulator impact and trigger for taking action - Oncology segment
    • Lagging indicators of accumulator-driven brand erosion
    • Lagging indicators of accumulator-driven brand erosion - Oncology segment
    • Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – Total benchmark class
    • Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – Total benchmark class and Oncology segment
    • Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – OOPC minimizers and Manufacturers with no OOPC progress
    • Voices from the field: Single-most critical factor for implementing copay accumulator mitigation strategy

    III. Copay Accumulator Mitigation Program: Strategy & Tactics Used

    • Importance of each of the listed objectives in the organization’s strategy for mitigating the impact of copay accumulator programs
    • Key copay accumulator mitigation strategy objectives – Total benchmark class and Oncology segment
    • 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 – Total benchmark class
    • Effectiveness of each of the listed steps for mitigating the negative effects of copay accumulator programs – Oncology segment
    • 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
    • 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 – Total benchmark class and Oncology segment
    • Percentage of total product revenue allocated by benchmarked organizations to financial assistance immediately prior to the existence of copay accumulators – Total benchmark class and Oncology segment
    • 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 – Total benchmark class and Oncology segment
    • Internal functions actively involved in molding strategy and executing activities to counteract copay accumulator programs – Total benchmark class
    • Internal functions actively involved in molding strategy and executing activities to counteract copay accumulator programs – Oncology segment
    • Internal functions actively involved in molding strategy and executing activities to counteract copay accumulator programs – OOPC minimizers and Manufacturers with no OOPC progress
    • Copay accumulator mitigation tactics - Total benchmark class and Expanded copay accumulator response team

    IV. Evaluating Operational Challenges, Program Success, and Lessons Learned

    • Metrics used to measure the overall performance of copay accumulator mitigation strategy – Total benchmark class and Oncology segment
    • Impact of copay accumulator mitigation efforts on the listed key areas
    • Impact of copay accumulator mitigation efforts on the listed key areas – Total benchmark class and Oncology segment
    • Difficulties in overcoming the listed operational hurdles in implementing copay accumulator mitigation strategy – Total benchmark class and Oncology segment
    • Difficulties in overcoming the listed operational hurdles in implementing copay accumulator mitigation strategy – OOPC minimizers and Manufacturers with no OOPC progress
    • Voices from the field: Incorporating inputs from copay vendors into copay accumulator mitigation strategy
    • Success stories of companies that have combatted copay accumulator programs
    • Most important lessons learned in launching efforts to mitigate the effects of copay accumulators

    V. Creating a Seamless Patient Experience

    • Effective tactics for supporting patients who face treatment disruption as a result of copay accumulator – Total benchmark class and Oncology segment
    • Case example of a real-time benefit investigation model developed by one innovative specialty manufacturer to determine optimal prescription payment & distribution model
    • Voices from the field: Strong existing patient support hubs are well-positioned to meet new challenges such as copay accumulators
    • Interview narrative around white-glove service within the patient support hub
    • Top lessons learned in ensuring a positive patient experience despite changes in how their treatment is financed

    VI. Future Threats and Market Access Challenges

    • Characterizing the threat posed by copay accumulator programs to the individual pharma organization and the pharmaceutical industry on the whole – Total benchmark class
    • Characterizing the threat posed by copay accumulator programs to the individual pharma organization and the pharmaceutical industry on the whole – Oncology segment
    • Likelihood of new payer / PBM payment policies circumventing pharma manufacturer’s copay accumulator mitigation strategy
    • Interview narrative around payer negotiations
    • Optimal path for resolving copay accumulator issues – Total benchmark class and Oncology segment
    • New payer strategies and tactics, besides copay accumulator mitigation activities, likely to negatively impact patients / manufacturers; potential mitigation tactics for these new payer strategies