Industry Voices—Leveraging business intelligence data to drive next generation co-pay design

Health insurance form payer plan enroll
AI and machine learning can be key tools in driving to next-generation co-pay design. (Valeriya/Getty)

Specialty therapies provide a powerful tool to treat patients with cancer and other complex conditions; however, millions of Americans face access issues and financial constraints that can impact their ability to afford specialty medications (PDF).  

As the COVID-19 pandemic has left millions unemployed, the number of people at risk, due to being uninsured or underinsured, has continued to climb. This makes them more likely to abandon their prescriptions or not remain adherent, which can result in negative health outcomes.

Many patients rely on co-pay programs from biopharma companies to help afford and remain adherent to specialty therapies. Patient-centric solutions such as co-pay offset programs, Patient Assistance Programs (PAPs) and alternative cash payment options have proven effective in helping to relieve financial pressures and maintaining adherence.

Leveraging AI and machine learning to identify and support patients

Designing and leveraging financial assistance programs require ongoing analysis and optimization, as well as integration with patient-centric support to drive better outcomes throughout the patient’s treatment journey.   

RELATED: Many customers face hurdles in accessing drug copay cards, GoodRx finds

While data has always been central to the design and management of co-pay programs, emerging AI and machine learning tools can help brands identify the therapeutic areas and patient cohorts most at-risk for affordability challenges.

For example, intelligence monitoring data confirms that co-pay maximizer models continue to experience steady growth while traditional accumulator programs remain stagnant.  According to RxCrossroads market data, as the utilization of specialty medications continues to increase, so do the benefits per claim, which increased 30% in 2019 and 71% in 2020.

After patients are identified, targeted outreach provides education and support to help patients understand the financial impact and options for access. Brands can deploy innovative business intelligence to advance patient savings programs and adherence in numerous ways, including optimizing coupon reach, improving targeting of offers, optimizing reporting, enhancing patient engagement, and improving physician and pharmacy messaging. 

These strategic interventions can provide the right type of support in the right setting to ensure continuity of care. These unique patient service offerings can range from helping eligible patients enroll into PAP and supporting the transition to and from commercial coverage, to providing pricing options that can significantly benefit patients based on their individual situation. Coupon program studies consistently demonstrate significant impact on adherence, and patients new to therapy outperformed the control group in terms of persistence, length of therapy, fill count, and time between fills, RxCrossroads by McKesson research finds.

Innovating to achieve next-generation affordability

During COVID-19, RxCrossroads by McKesson has worked with biopharma customers to adjust program rules and ease eligibility guidelines for affordability programs to help patients receive uninterrupted access to therapies. This has included streamlining program enrollments and targeting highly impacted and at-risk regions to bring forward coupon and affordability support programs direct to prescribers and pharmacies in those regions.

We are dedicated to working with biopharma companies to find innovative solutions for providing support.  Moving forward, these newfound efficiencies and robust business intelligence tools will support next-generation co-pay models that structure benefits to ensure optimal adherence and retention among patients—driving access to life-changing therapies and interventions at the right time, in the right place, to the right patient, delivering better care and outcomes.

Steve Mink is vice president of product and market development at RxCrossroads by McKesson.