Home 9 All 9 What to Do When Your Brand Sees a Sudden Rise in Copay Costs
Grace Bergin
  •  February 06

What to Do When Your Brand Sees a Sudden Rise in Copay Costs

Copay programs play a pivotal role in ensuring patient access to life-changing medications.
What to Do When Your Brand Sees a Sudden Rise in Copay Costs
Copay programs play a pivotal role in ensuring patient access to life-changing medications. Recently, however, the rise and evolution of accumulator and maximizer programs has posed significant challenges for pharmaceutical manufacturers in balancing patient access and program viability. If your copay program has recently seen claims skyrocket, you’re not alone. This blog post outlines five proactive steps your organization can take to tackle the many copay challenges in the market today.

1) Understanding the Evolving Landscape

The first step for brand teams is to comprehensively understand the market landscape and the evolving nature of accumulator and maximizer programs. The copay environment is dynamic, with trends in accumulators, maximizers, and Alternative Funding Programs (AFPs) altering significantly in the last few years alone. Understanding and staying ahead of these changes ensures that brand teams can analyze and adapt their copay programs effectively.

2) Analyzing Copay Claims and Identifying Trends

An in-depth analysis of copay claims is imperative for brand teams to identify trends and examine the impact of accumulators, maximizers, and AFPs on their programs. By dissecting these elements, teams can gain insights into their current copay programs’ effectiveness and identify improvement areas. If your team doesn’t have the internal capabilities to do this, hiring an external expert may be a good option.

If any of these questions resonate with you or your 3PL program, it’s likely time to conduct a health check on your third-party logistics partner and current services.

3) Optimize Business Rules to Reduce Exposure

Once armed with a comprehensive understanding of the market and your program’s copay claims, manufacturers can turn their attention inward. Internally evaluating and modifying business rules and program designs can significantly reduce exposure to accumulator and maximizer programs. This may involve introducing new terms and conditions, adjusting copay structures, or refining program designs to better align with patient needs and market realities.

4) Exploring External Vendor Solutions

In addition to internal changes, the capabilities offered by external vendors play a significant role in mitigating copay program exposure. Brand teams should explore the full range of vendor solutions available in the marketplace, with both traditional copay vendors and niche copay experts. Collaboration can provide innovative solutions to address the challenges posed by identifying and solving for accumulators and maximizers.

5) Considering the Future Landscape

In the fast-paced copay landscape, anticipating trends is essential for long-term success. When designing a program, teams should consider what the copay space may look like over the coming months and years. Aside from accumulator and maximizer evolution, other factors likely to play critical roles include ongoing state and federal legislation, manufacturer lawsuits, and upcoming challenges in the space, including AFPs. Adopting a forward-thinking approach ensures that copay programs align with the evolving needs of patients and market access.

Navigating the complexities of accumulator and maximizer programs requires a strategic and multifaceted approach. Suppose your brand has seen a sudden increase in copay costs, and you think these challenges may affect you. In that case, Archbow can work with your team to ensure that your program effectively navigates these challenges and ensures your patients continue to receive the highest standards of product access. Contact us today to learn how Archbow can help with your copay programs.

Learn more about Team Archbow and the methodology that matters most to successful programs, and contact us today for assistance with your strategic and tactical patient support and distribution needs.

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Archbow Consulting helps pharmaceutical and biotech companies in the USA and Europe design, build, and optimize product distribution and patient access strategies. Archbow was founded by industry veterans to meet a need in the marketplace for consulting options that offer diverse real-world experience, are able to leverage deep connections across the industry, and can also provide actionable strategic guidance. We invite you to learn more about our team, services, and clients’ success, and connect with us via email, LinkedIn or subscribing to this blog which you can do below.

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