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Health Plans vs. Drugmakers: The Battle Over Copay Subsidies November 5, 2009 George Van Antwerp, GM, Silverlink Communications
Today’s Topics What types of drugs do copay subsidy programs target, and how do they work? What are the differences between copay subsidy programs targeting specialty drugs versus those for other medications – and how should health plans respond? How can payers use step therapy, generic promotion and other programs to target classes that subsidies are focused on? How can health plans ensure that copay subsidy programs don’t compromise patient safety? What is the impact on drug dispensing rates? How can adjustments to tier structures make copay subsidies less attractive? What operational issues much be considered when implementing such a tiered structure adjustment?
Changing Business Models Employers and others are willing to be more aggressive around plan design Generics are the default solution Drug pipelines are weak Physicians are less likely to see pharma reps Coupons as “virtual samples” (less expensive) Online health / technology ubiquity CDHP / high deductibles Shift to coinsurance
Rx Copay Coupons
What Drugs Do They Target? Non-Formulary  Competitive categories Drugs that recently lost patent protection Chronic New therapy High cost specialty medications
How Do They Work? Physical or digital card Require patient registration DTC and physician focused Get people started on a brand medication Mostly POS versus rebates
InternetDrugCoupons.com
How Should Payors Respond? Non-Specialty Medications Increase the delta between generics and non-formulary drugs Lower the cost of generics Make the consumer pay the majority of the drug cost (even with the coupon) Close the formulary Implement step therapy Not allow coupons to be used in their retail network or at their mail pharmacy Push manufacturers to tie them to adherence Offer adherence rewards to consumers Educate consumers and physicians about risks of couponing
How Should Payors Respond? Specialty Medications Continue to drive consumers to a limited specialty network Partner with manufacturers to allow coupons where clinically appropriate to lower costs Don’t take coupons not provided by the specialty pharmacy directly Health plans should embrace specialty coupons that support cost-effective therapies; reduce copay burden; and potentially impact adherence.

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Rx Copay Coupons

  • 1. Health Plans vs. Drugmakers: The Battle Over Copay Subsidies November 5, 2009 George Van Antwerp, GM, Silverlink Communications
  • 2. Today’s Topics What types of drugs do copay subsidy programs target, and how do they work? What are the differences between copay subsidy programs targeting specialty drugs versus those for other medications – and how should health plans respond? How can payers use step therapy, generic promotion and other programs to target classes that subsidies are focused on? How can health plans ensure that copay subsidy programs don’t compromise patient safety? What is the impact on drug dispensing rates? How can adjustments to tier structures make copay subsidies less attractive? What operational issues much be considered when implementing such a tiered structure adjustment?
  • 3. Changing Business Models Employers and others are willing to be more aggressive around plan design Generics are the default solution Drug pipelines are weak Physicians are less likely to see pharma reps Coupons as “virtual samples” (less expensive) Online health / technology ubiquity CDHP / high deductibles Shift to coinsurance
  • 5. What Drugs Do They Target? Non-Formulary Competitive categories Drugs that recently lost patent protection Chronic New therapy High cost specialty medications
  • 6. How Do They Work? Physical or digital card Require patient registration DTC and physician focused Get people started on a brand medication Mostly POS versus rebates
  • 8. How Should Payors Respond? Non-Specialty Medications Increase the delta between generics and non-formulary drugs Lower the cost of generics Make the consumer pay the majority of the drug cost (even with the coupon) Close the formulary Implement step therapy Not allow coupons to be used in their retail network or at their mail pharmacy Push manufacturers to tie them to adherence Offer adherence rewards to consumers Educate consumers and physicians about risks of couponing
  • 9. How Should Payors Respond? Specialty Medications Continue to drive consumers to a limited specialty network Partner with manufacturers to allow coupons where clinically appropriate to lower costs Don’t take coupons not provided by the specialty pharmacy directly Health plans should embrace specialty coupons that support cost-effective therapies; reduce copay burden; and potentially impact adherence.

Editor's Notes

  1. So, while employers and payors are looking for ways to save money by more aggressively promoting utilization management and generics, the manufacturers are looking for ways to maintain market share even as patents expire. You combine that with a continued rise in consumerism and online health activities and it creates a new channel for manufacturers. While they were traditionally limited in their ability to get “samples” into the hands of consumers and know who those consumers are, coupons change that. And, finally with the stretched consumer, any savings can look attractive especially things that allow them to get credit towards their deductible, but save money.
  2. This has driven the rise of online couponing sites and you see companies like AARP and others promoting them. Most people don’t fully appreciate the fact that the coupons are primarily offered on drugs with generic equivalents or in highly competitive classes where the payor cost is likely going up as the consumer stays on or shifts to the couponed drug. And, if you don’t know, typically manufacturers will rapidly increase the price of their drug once the patent expires or even before that to make as much money as possible off those that stay on the medication.
  3. There are probably a few exceptions, but in general, coupons are focused on chronic medications that are either: New to market Off formulary (i.e., non-preferred) In highly competitive categories Or are specialty drugs where the member’s contribution could be significant
  4. If I’m a manufacturer, coupons are much preferred to samples. They only incur product costs when the coupon is used. The member has to “register” to receive the coupon giving them patient information. They should allow them to maintain or gain marketshare. And, the big question is whether they drive adherence and therefore have some relevant health outcome.
  5. Here’s an example of one of the sites out there. As you can see, there are links to dozens of coupons here. You can print coupons from the page. As you can see on the next page (turn slide)
  6. So, how should payors respond to non-specialty medications…