Sempre Health partners with Organon on pricing program that ties patient copays to adherence

Sempre Health launched eight years ago with a text-based solution that gives patients a financial incentive to refill medications on time.

The aim is to improve medication adherence and affordability for patients while the company also builds out a two-sided network of payers and life sciences companies.

Sempre Health has now added Organon to its list of partners. Eligible patients who refill their prescriptions on time and as prescribed for certain asthma therapies are able to receive discounts on their medications throughout the course of their therapy, according to the companies. The program specifically targets the Merck & Co. spinout's Dulera and Asmanex branded therapies.

"Two unique aspects of Sempre are that we are aligning these two stakeholders to drive affordability and adherence where I don't think a business model like that exists today. And, we effectively engage the patient through a combination of behavioral economics-based dynamic pricing and SMS engagement," Anurati Mathur, CEO of Sempre Health, said in an interview.

The company provides a mobile text-based platform to insurers to offer large prescription copay discounts to members for filling their prescriptions on time. It's a similar approach to "good driver" programs offered by car insurance companies.

The company works with health plans and life sciences companies to dynamically adjust patient copays based on individual adherence and behavior seamlessly at the point of fill. 

Sempre Health sends enrolled patients text messages offering discounts that encourage them to fill and pick up their medications quickly. A text message might offer a patient a discounted copay to pick up the prescription within the week and another a higher price if he or she waits.

Eligible patients receive discounts at the point of sale, which increase as they remain on therapy and continue to fill on time, helping them fill their medications and save money. The program also includes natural language text message engagement, which leads to a personalized experience for those enrolled, according to the company.

The company's incentives and reminders drive more on-time refills and lead to patients staying on therapies longer, according to the company.

Based on several internally and externally validated studies, Sempre Health claims that its program can boost medication adherence by greater than 20% and drives a 95 Net Promoter Score.

An analysis of 14,000 patients using the Sempre Health program compared with 58,000 patients not using the program found that 27% more patients in the Sempre cohort filled their 12th prescription refill compared to the other cohort, Mathur said. The program's approach is capturing 36% more fills over a 24-month period, according to the company.

"I think this really illustrates the value not just to the manufacturer or the health plan, but these are fills that patients would not have been able to afford or access without the intervention and this is a big part of what both sides of the marketplace like about the program," she said.

Patients find the cash discounts to be a powerful incentive, according to testimonies that Sempre Health provided.

"This offering has meant the world to me. I did not take this medication every day before. I used it sparingly, as I could not afford to refill it every month. Now I’m able to better afford my medication as prescribed," said one patient already enrolled in the program.

The company now works with 18 health plans, including UPMC Health Plan, Highmark, a number of Blues plans and large national plans, and has 10 to 20 medications on its platform, Mathur said.

Sempre Health's platform has historically focused on chronic disease medications addressing cardiovascular, metabolic and respiratory disease states. "Asthma is a disease state that's particularly difficult for patients because it literally affects your ability to breathe. A lot of the patient feedback that we've received thus far is around the affordability piece and really making it possible for them to take these medications on a regular basis and to afford these medications," she noted.

Approximately 75% of patients in the U.S. struggle to take their medicines as directed due to several factors including prohibitive high costs and copayments for prescription medicines, managing multiple medications, complex treatment regimens or poor health literacy. Non-adherence to medication presents a significant clinical and economic issue in the U.S. with annual costs between $100 billion to $300 billion, according to some financial estimates.

"On the life sciences side, every one of our partners is very focused on driving affordability and adherence. A number of our partners have programs in place already, whether it's in the form of copay cards or other patient assistance solutions that are really aimed at driving that outcome for patients, and we can sit alongside many of those strategies," Mathur said. "On the payer side, I think there's a lot of alignment around these medications to drive affordability and adherence as well as that member satisfaction piece. I think that resonated with the Blues plans and the large nationals that we're working with on the payer side."

"This partnership represents a significant step forward in expanding access to medicines, and the ability to help eligible patients adhere to their treatments while also saving money is a winning combination,” said Ger Brennan, vice president and commercial lead, established brands at Organon, in a statement. “The innovative digital platform that Sempre Health provides is extremely exciting and we are pleased to have our medications included as part of this offering, ultimately making it easier for enrolled patients to manage their health.”

Sempre Health has raised $45 million to date backed by Blue Venture Fund, UPMC Enterprises, Industry Ventures, Cencora Ventures, Echo Health Ventures and other investors.

For next year, the company is focused on accelerating the growth of its two-sided network of pharma manufacturers and health plans as well as launching products for new populations.

"The scale of our platform has increased substantially in the last 12 months and will increase even more quickly with some of our partners coming on in Q1 through the rest of next year," Mathur said.

"We've also recently launched programs in the Medicare and generics space for the first time, and that's a slightly different business model. I think this is a testament to the value that we're driving for patients and allows us to address a far wider suite of medications and patients," she said.