Co-pay Card Program Monitoring and Optimization November 2014

Transcription

1 Primary/Final Payer Analysis Co-pay Card Program Monitoring and Optimization November 2014

2 Symphony Health Solutions offers an array of Managed Markets Studies CONSULTING/ANALYTICAL STUDIES Managed Markets Landscape Dynamic Claims Lifecycle Data Primary/Final Payer Co-pay Card Monitoring Co-pay Card Optimization Segmentation Payer Prescriber Payer & Prescriber Leaky Bucket Analysis Medicare Part D Donut Hole Analysis ONLINE REPORTING TOOLS Market Profiler Access Investigator Dynamic Claims Lifecycle Analyzer Decision Flow ADDITIONAL SERVICES Ad-hoc Reports and data sets Data set subscriptions Executive Summaries Cloud Hosted Solutions

3 Increasing Patient Burden Has Been Accompanied by Increased Utilization of Co-pay Offset Programs Payer Rebates $40 Billion in Payer Rebates annually from Pharmaceutical Manufacturers to allow patients access to their medications, with an estimated $32B increase over the next decade. Direct to Consumer Rebates/Co-pay Cards In addition, manufacturers have increasingly utilized direct to consumer rebates in the form of copay cards and vouchers to bring down the financial burden on the patient to the tune of $4B/year. What comes next? How will payers react? What does the data show about the impact and ROI of programs?

4 Primary/Final Payer Analysis leverages exclusive PayerSource data, providing best-in-class payerfocused data Exclusive Advantages Payer Visibility Price Sensitivity Brand Substitution Benefit Design Details Specialty/Mail Order Primary and Final Payer Visibility Co-pay Card Program Monitoring Co-pay Card Program Optimization

5 Co-pay Card Monitoring addresses key business questions related to the impact of existing programs How many claims are adjudicated with a brand copay card? When a copay card is used, how much is the initial copay? How much did the co-pay card pay for the prescription? When using a co-pay card, who is the patient's primary health insurer? How much is the patient s final co-pay after using the co-pay card? Double Rebating - What is the true cost of drug? (Payer contracting plus the cost of the co-pay card) When a co-pay card is used, how much did the primary health insurer pay? Are your program's business rules working properly? What is the impact of the brand's total rebate spend on incremental prescription claims?

6 Primary and Final Payer Data reveals utilization of co-pay cards back to the patients RX benefit provider Managed Care Organization RXs with Co Pay Card Avg. Primary Payer Co-Pay Avg. Final Payer Co-Pay Avg. Buy Down from Co Pay Card Program UNITED HEALTH GROUP 17,152 $68.24 $20.43 $47.81 AETNA US HEALTHCARE 5,059 $57.19 $20.71 $36.48 CIGNA HEALTHCARE 4,083 $54.34 $20.53 $33.81 HCSC 3,703 $65.99 $20.59 $45.40 RXs going through a co-pay card RXs going through a single payer Unmask RXs back to Payers with and without co-pay cards and the benefit designs for the original (primary) payer and the final (co-pay card) payer Managed Care Organization RXs without Co Pay Card Avg. Primary Payer Co-Pay Avg. Final Payer Co- Pay Avg. Buy Down from Co Pay Card Program UNITED HEALTH GROUP 51,456 $58.86 $58.86 $0 AETNA US HEALTHCARE 13,236 $46.48 $46.48 $0 CIGNA HEALTHCARE 11,685 $55.45 $55.45 $0 HCSC 12,075 $54.61 $54.61 $0

7 Primary/Final payer analysis shows the impact of double rebating RXs - Payer Rebates vs. Co-pay Cards 100% Total RXs Revenue Dollars Total UHG Rebate Dollars $1,013,790 50% $16,075,200 $1,526,430 0% With Co-pay Card $5,068,950 United Without Co-pay Card $3,215,040 CONTRACTED MCO WITH co pay CARD TRX INITIAL copay FINAL copay AVG COST PER RX TO PHARMA UNITED HEALTH $68.35 $23.18 $45.17 With Co-pay Card Rebate to Payer Without Co-pay Card Rebate to Payer Co-pay Card Rebate to Patient A $150 Rx Drug 20% Rebate to United 24% of TRX are associated to a co-pay card Offset amount in United is $80.17 per TRX associated to co-pay card $21.1M in TRX Revenue with $5.75M in Total Rebates $5M in co-pay Card TRX Revenue with $2.54M in Total Rebates 24% of the TRXs is driving 44% of Rebate Dollars

8 Co-pay Card Optimization studies analyze changes to current programs and optimize new programs Does your brand really need a co-pay buy-down program? What have the results been of previous programs, including competitor programs? What is the potential market impact of a co-pay buy-down program? What is the expected impact on patient fill rates? What is the ideal benefit design for your co-pay card program? What program design optimizes ROI and limits unexpected financial exposure? What can the slope of a price-sensitivity curve tell you about the potential ROI of your program? What is the difference in market opportunity with a buy-down to $35, versus $25? What is the expected co-pay card program ROI? What price-point(s) tend to keep patients persistent with their course of therapy? At a $35 co-pay, how many prescriptions will a patient fill within 12 months? How does that change if the patient is faced with a $25 co-pay? Is a co-pay card the best solution? Or should other alternatives (electronic voucher, etc.) be used?

9 Co-pay Optimization Studies evaluate the impact of existing and new programs to recommend options to improve ROI Transactional level insight into patient s Primary Plan Pay shows initial co-pay amount and Final Plan Pay (co-pay card) provides insights into how much the brand is subsidizing the Rx Determine the Need: Competitive landscape assessment Program Design: Determine appropriate levels and limits for program Deployment of Program: Optimize allocation of resources to maximize ROI Program Evaluation: Determines program profitability and areas to increase ROI

10 Co-pay Card Analytics DELIVERY OPTIONS PowerPoint Executive Summary Transactional Level Data Summarized Data Functional Models for Optimization FREQUENCY OPTIONS Monthly Quarterly Semi-Annual One Time Ad-Hoc OTHER OPTIONS National Level Geographical Cuts - State, CBSA, Territory or Physician Level MCO or Plan Level