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

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.

• 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

• 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.

I.	Executive Summary
	Research Overview	pg. 3
	Key Findings	pg. 6
II.	Full Study Data
	Quantifying the Copay Accumulator Threat	pg. 13
	Key Indicators of Copay Accumulator Impact on Specialty Products	pg. 20
	Copay Accumulator Mitigation Program: Strategy & Tactics Used	pg. 32
	Evaluating Operational Challenges, Program Success, and Lessons Learned	pg. 57
	Creating a Seamless Patient Experience	pg. 67
	Future Threats and Market Access Challenges	pg. 73
III.	About Best Practices, LLC	pg. 80

• 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

• 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

• 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

• 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

• 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

• 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