Copay and e-Voucher Redesign for Improving Patient Access
Background
- New indication launch for leading T2D brand
- Significant investment in payor rebates to maximize patient coverage
- Evaluating additional investment in patient support programs (copay, e-vouchers) to overcome patient affordability barriers
- KBQs: What is the expected reversal rate for covered patients with no, low, medium and high out-of-pocket expenses? What is an acceptable reversal rate from a brand profitability perspective?
Objective
Conduct competitor analysis to assess patient reversal trends associated with varying levels of patient out-of-pocket expenses.- Identify low, medium and high patient copayment segments for competitor brand
- Assess the impact of copay card/e-voucher utilization on reversals for these low, medium and high copay segments
- Model various copay design options for the launch brand - determine optimal incremental patient conversions based on profitability (ROI)
Approach
Leveraged adjudication and payor hierarchy data to design optimal copay/e-voucher program to minimize reversal among new and existing patients.- Stratified competitor patients into low, medium and high copay segments based on recent history
- Determined impact of copay cards/e-vouchers buydown for low, medium and high copay segments through retrospective patient cohort analysis
- Simulated scenarios to project patient conversions and ROI for PALA (pay as little as) , max buydown, max threshold, min threshold (up to patient copay) options
- Recommended optimal copay/e-voucher plan design
Insights & Results
- Significant ~20% reduction in reversal rate among new patients utilizing copay / e-voucher support
- Copay design parameters: PALA $10, max buydown $175 covering patients between $80 - $275
- E-Vouchers: Automatic buydown of $39.99 for patients between $120 - $275
- Achieved 90% new patient conversion launch goal