Copay Assistance Programs for Patients

Las Vegas—With several blockbuster drugs losing patent protection in recent years, companies have increased their use of copay or voucher programs, in which drug or device manufacturers provide financial assistance to patients to continue using the brand drugs.

Some of the initiatives include providing free samples or reduced copays, but “there is a lot of variation,” according to Dea Belazi, PharmD, vice president of payer and healthcare solutions at Source Healthcare Analytics.

Speaking at the PBMI conference, Dr. Belazi said the programs are intended for private commercial insurance, not for Medicare or Medicaid. They are usually combined with other third-party insurance coverage and are aimed at reducing costs for patients, helping companies to sell their drugs.

Source Healthcare Analytics performs data analysis for numerous pharmaceutical parties, including providers, payers, and patients. The company gets its information from pharmacy terminals, National Council for Prescription Drug Programs claims, third party claims, and other sources.

Dr. Belazi noted that drug companies make programs such as a free trial for a specified number of prescriptions, savings up to a certain dollar amount, or a specified patient payment amount available to patients through their physician offices or pharmacies, via advertising or direct mail, or on various websites.

Of the nongovernment insurance prescription claims paid for in 2012, 2.44% were associated with a copay coupon program. Andy Szczotka, PharmD, practice lead of payer initiatives at Source Healthcare Analytics, said the percentage was still low, but it is growing and is up from 1.12% in 2010 and 1.60% in 2011.

Between 2010 and 2012, 10 therapeutic classes accounted for 55% of copay coupon card utilization, according to Dr. Szczotka. The classes are antihypertensive drugs, oral diabetes therapies, nonbarbiturate sedatives, anticonvulsants, tetracyclines, inhaled nasal steroids, beta agonist aerosols, synthetic narcotic analgesics, cholesterol reducers, and beta agonists.

During that same time period, the following drugs were associated with the highest copay coupon utilization: Advair Diskus (fluticasone propionate and salmeterol inhalation powder), Lipitor^® (atorvastatin calcium), Suboxone^® (buprenorphine and naloxone), Beyaz^® (drospirenone/ethinyl estradiol/levomefolate calcium tablets and levomefolate calcium tablets), Ventolin^® HFA (albuterol sulfate), Lunesta^® (eszopiclone), Lamictal^® (lamotrigine), Enbrel^® (etanercept), Singulair^® (montelukast sodium), and Dexilant^® (dexlansoprazole).

Dr. Szczotka noted that people typically use the copay coupon programs with their regular insurance coverage. In 2012, 75% of people used the copay coupon as the secondary payer, while 25% used it as the primary payer. For the average prescription price of $402.98 in 2012, the insurer covered $327.19 (82.0%) of the cost, while the copay sponsor covered $53.05 (13.2%) and the patient covered the remaining $22.74 (5.8%) of the cost. The percentages were similar in 2010 and 2011, although the average price was lower ($344.24 in 2010 and $382.62 in 2011).

The effects of copay coupon programs are especially helpful for patients taking specialty medications, according to Dr. Szczotka. For the average specialty prescription price of $2364 in 2012, the insurer covered $2189 (92.6%) of the cost, while the copay sponsor covered $158 (6.7%) and the patient covered the remaining $17 (0.7%) of the cost. For the average traditional prescription price of $281 in 2012, the insurer covered $211 (75.1%) of the cost, while the copay sponsor covered $47 (16.7%) and the patient covered the remaining $23 (8.2%).

Source Healthcare Analytics examined different programs. In copay coupon programs with a generic equivalent, the average total cost for a prescription claim was $200.84: the insurance company covered $139.45 (69.4%) of the cost, the copay sponsor covered $45.74 (22.8%), and the patient covered $15.65 (7.8%). In copay coupon programs with a no generic equivalent, the average total cost for a prescription claim was $298.68: the insurance company covered $226.98 (76.0%) of the cost, the copay sponsor covered $46.87 (15.7%), and the patient covered $24.83 (8.3%).

The company also evaluated the 3 most commonly utilized copay assistance programs from 2010 through 2012. In the 12 months after patients filled their prescriptions using a copay program, there was a 73% improvement in persistency. At 12 months, approximately 40% of patients who used a coupon program remained on therapy compared with 30% of patients who did not have a coupon program.

The persistency depended on the drug. For example, there was a 175% improvement in patient persistency at 12 months for patients taking atorvastatin calcium compared with a 56% improvement associated with Solodyn^® (minocycline) and a 38% improvement associated with fluticasone propionate and salmeterol inhalation powder.

Further, for patients enrolled in the 3 most commonly used copay assistance programs from 2010 through 2012, the average time the patients stayed on therapy was 147 days compared with 114 days for patients who did not participate in a coupon program.

The patient longevity and effectiveness of the program varied based on the drug taken. Patients who took fluticasone propionate and salmeterol inhalation powder stayed on therapy for an average of 105 days if they were in the coupon program, while the average length was 98 days for those who did not have a coupon. Patients who took atorvastatin calcium remained on therapy for an average of 186 days if they had a coupon and 127 days if they did not have a coupon. For patients who took minocycline, the average length of stay on therapy was 101 days if they had a coupon and 86 days if they did not have a coupon.

Dr. Szczotka said the reasons for rejected copay prescription claims vary. The company’s analysis of the top 3 copay programs found that the most common reason for rejection was plan limitations were exceeded (39%), followed by the product or service not being covered (17%), and patients attempting to refill prescriptions too soon (4%). For commercial programs, the most common reason given for rejecting a claim was refilling the prescription too soon (32%), followed by the product or service not being covered (12%), and the claim requiring prior authorization (12%).

An analysis of 7 top therapeutic classes found that program sponsors contributed an average of $60.34 for the average prescription in copay assistance programs in 2012, down from $65.94 in 2011 and $75.79 in 2010. Meanwhile, the average patient contribution was $18.04 in 2010, $22.42 in 2011, and $22.61 in 2012.

Whereas copay programs were originally consistent throughout the United States, Dr. Belazi said they are now being tailored based on the region of the country.

“That is where the industry is going,” Dr. Belazi said.