Oncology Co-Pay Assistance Programs: Manufacturers Aggressively Address Patient Cost-Sharing

Lina Genovesi probes the implications of the rise of oncology costs on managed care organisations, employers and patients and the rise of co-pay assistance programs and their effect in defraying patient cancer costs.

According to the 2013 Genentech Oncology Trend Report, oncology costs continue to rise with the cost of cancer drugs as the most significant driver of the overall costs of cancer care. Managed care organizations, employers and patients are all affected. Managed care organisations and employers are forced out of necessity to control the cost of cancer drugs and co-pay assistance programs, which offer financial assistance to reduce a patient’s co-pay for a pharmaceutical product, have emerged as an attractive option for patients to defray the cost of cancer drugs for patients.

Addressing Cancer Costs

The majority of managed care organisations use a pharmacy benefit organisation to help manage and administer drug benefits and control cancer drug costs by using specialty pharmacy networks, incentivising physicians to use generic oncology drugs. These specialty pharmacy networks control costs by promoting the use of preferred drugs, and negotiating with manufactures for better pricing. Employers carve out cancer drug management to a vendor specialising in cancer care. They also encourage generic drug use and increasing detection program participation and investing in health promotion programs to control costs.

“Absorbing the cost of cancer care is a challenge on insured and noninsured patients alike. Co-pay assistance programs have emerged out of necessity and are attractive to absorb these costs,” states Christopher J. Wheeler, JD, Director, Co-Pay Strategies, Zitter Health Insights. “These programs are classified into three categories depending largely on the target population.”

The three categories include:

  • Co-pay offset programs involving a manufacturer co-pay program for branded pharmaceutical products and geared at the commercially insured population;
  • Patient assistance programs involving a manufacturer-sponsored co-pay assistance non-profit foundation or program and geared to help uninsured patients (or those denied coverage by their commercial plans) that meet specific financial eligibility criteria; and
  • Foundational assistance programs involving an independent non-profit foundation or program and geared to help underinsured commercial or publicly insured patients that meet specific financial eligibility criteria.

All types of co-pay assistance programs help offset out-of-pocket costs and drive adherence even though they serve different populations. Redemption data is only available on co-pay offset programs, as patient assistance programs do not run through the adjudication process and independent foundations, because of their mandate, do not share specific manufacturer utilisation rates.

These programs improve access to therapies and physicians are in general agreement that co-pay programs influence their decision to prescribe a newly approved drug and that co-pay assistance programs improve clinical outcomes across the board.

“This makes it harder to compare one program against the other. In terms of overall value to the patient, many factors should be considered.  Patient assistance programs provide free drugs to qualifying patients. Foundational assistance programs also serve the low income population.  Co-pay offset programs, on the other hand, are more diverse and flexible.  The latter two types usually require some patient contribution”.

“These programs improve access to therapies and physicians are in general agreement that co-pay programs influence their decision to prescribe a newly approved drug and that co-pay assistance programs improve clinical outcomes across the board. Pharmacists also believe that co-pay offset programs improve uptake and compliance.”

Challenges of Co-Pay Assistance Programs

Even though these programs are effective in defraying the cost of a drug, they present certain challenges to patients and manufacturers alike. 

“Programs that don’t work efficiently or are otherwise difficult for patients to use make them a hassle, and as such, they may not be worthwhile, depending on the benefit.  For manufacturers, the challenge is in the design and monitoring. As internal and external scrutiny on these programs increases, so too does the scrutiny increase on the program manager to design an effective program and achieve results desired.”

“The Co-Pay Offset Monitor is a research and analysis tool that provides benchmarking and monitoring of key performance insights,” states Wheeler. “It helps biopharmaceutical manufacturers optimise programs and physician and patient messaging strategy with stakeholder utilisation and transactional data insights. The data from the Co-Pay Offset Monitor can be extremely useful in making informed decisions thus reducing the challenges involved. ”

“The Co-Pay Offset Monitor is designed to provide the pharmaceutical marketer with insight into drivers behind co-pay program utilisation and make informed strategic decisions regarding co-pay assistance issues, and monitor current developments in the co-pay program industry.”

Co-Pay Assistance Programs are likely to become more relevant

Co-pay assistance programs are likely to become more relevant within the landscape of the Affordable Care Act due to the transition of a massive population of uninsured patients to insured patients.

“Presumably, this population of patients will consume pharmaceutical products and demand co-pay assistance.  Increasingly, the ACA provisions lead us toward a system of more accountability for healthcare outcomes across stakeholders.  Programs, like co-pay assistance programs, that help drive better clinical outcomes should benefit from an increased demand for these programs,” states Wheeler.

Given the current landscape of the rising cost of cancer care, the impact of the Affordable Care Act, and the continued focus of the pharmaceutical industry on specialty pharmaceutical products, the need for co-pay assistance programs is likely to increase as these programs become more tailored to the needs of the specific stakeholders.


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