Moving From Offers to Solutions ALIGN CHANNEL STRATEGIES WITH PATIENT NEEDS TO REDUCE ACCESS BARRIERS Doug Gabbard The views and opinions expressed and presented here are my own and do not reflect the views and opinions of AstraZeneca
Everything should be made as simple as possible, but not simpler. The simplest explanation with edits from Legal
Agenda Historical Perspective Todays Challenges Improving Affordable Access Program Design and Channel Mix
How did these get started Where did it begin? 1987 Prescription Drug Marketing Act placed restrictions on product samples This created the need for an easier way to enable product trial for patients Vouchers were born to perform as samples Savings cards created ongoing savings beyond first use Where do they fit in today? Restricted formulary access High deductible health plans Non-sampling clinics
The Vicious Circle 1. Rising healthcare costs are increasing medication copays 2. Higher copays shown to reduce medication adherence rates 3. Low medication adherence associated with poor disease control 4. Poor disease control negatively impacts patient health outcomes 5. Poor health outcomes increases healthcare costs
What does the data say? Recent report published by CVS Health Research Institute says The results of this systematic review of past studies suggests that restricting the availability of prescription drugs or prohibiting access could have collateral negative effects on patients' health and may not produce the expected cost-savings Study findings related to use of enhanced/expanded drug insurance programs: 1. More patients were able to afford important medications and were more adherent 2. Decreased costly complications and overall health care use, including hospitalizations 3. Several studies also showed a negative impact on patient health outcomes when insurers placed burdensome caps on drug benefits 4. Authors observed a consistent link between drug insurance and improved patient health status. Source: American Journal of Public Health, Brigham and Women's Hospital and the CVS Health Research Institute
What does the data say? Report published by CVS Health Research Institute says cost is the strongest predictor of abandonment The data shows abandonment rates: 1.4% for co-pays of $10 or less 3.4% for co-pays between $30 and $40 4.7% for co-pays of $50 patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10 Source: Annals of Internal Medicine, Harvard, Brigham and Women's Hospital and the CVS Health Research Institute
Patient Cost Sensitivity Physician Perspective RHEUMATOID ARTHRITIS Survey collected: 08/2014 to 09/2014 Physicians are indicating that patients are bringing up the affordability of their medication. 60% of physicians first look to co-pay programs when their patients indicate they cannot afford meds. PATIENTS INDICATING NON-AFFORDABILITY FOR THEIR CURRENT MEDICATIONS - FREQUENCY Never (1) Sometimes (2,3) Very often (4,5) n = 144 physicians 58% 42% WHAT DO YOU DO NEXT? Search for savings such as co-pay programs 60% Refer them to your case manager 17% Switch them to a cheaper therapy 12% Tell your patients that assistance is available; they just need to search the internet 7% Keep them on the medication (drug is very important) Other 1% 2% Q: How frequently do patients indicate they cannot afford their current medications? Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015 Q: When patients indicate they cannot afford their medication, do you typically: (options listed in chart)
Cost and Primary Stakeholder Behavior DIABETES Survey collected: 12/2014 to 1/2015 47% of surveyed physicians report of switching the drug to a cheaper therapy when patients indicate non-affordability. Pharmacists report to try more for searching savings offer than physicians. WHEN PATIENTS INDICATE THEY CANNOT AFFORD THEIR MEDICATION, WHAT DO YOU DO NEXT? Physicians Pharmacists Switch them to a different cheaper therapy 47% Switch them to a different cheaper therapy 25% Search for savings such as co-pay offset programs 32% Search for savings such as co-pay offset programs 54% Refer them to your case manager 7% Tell your patients that assistance is available, they just need to search the internet 7% Tell your patients that assistance is available, they just need to search the internet 21% Other 4% Keep them on the medication (drug is very important) 4% N = 108 physicians Other 2% N = 61 pharmacists Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015 Emerging category in a highly competitive therapeutic area
Cost sensitivity DIABETES Survey collected: 12/2014 to 1/2015 Patients report that they will stop filling their prescriptions once their co-pay hits around $85. HOW MUCH IS YOUR CO-PAY FOR: $90 Patients Generic drug co-pay Branded drug co-pay $80 $70 $60 $50 $40 Average co-pay at which patients report to start looking for savings = $ 51.43 (n = 209 patients) Average co-pay at which patients report to stop filling prescriptions = $ 85.83 (n = 209 patients) $30 $20 $10 $- $41 $44 $12 $12 $12 $11 Therapeutic area average (n = 209) Category average X (n = 119) $39 Category average Y (n = 51) $44 Category average Z (n = 75) Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015
Population Mix Diabetes Study Diabetes O V E R A L L P O P U L AT I O N M I X A L L P R E S C R I P T I O N S v s. P R E S C R I P T I O N S W I T H C O - PAY C A R D All Prescriptions (n=2,056,247) Rxs with co-pay card (n=161,202) 84% 55% 39% 4% 7% 3% 2% 7% Paid by Cash (n=72,493/10,634) Commercially Insured (n=1,135,893/135,537) January 2014 June 2014 Government Insured * (n=799,748/4,232) Other (n=48,116/10,799) Patients were enrolled in a 6-month ( January 1, 2-14 to June 30 2014) cohort and were followed for 6 months. Co-pay card users were determined during the enrollment period and the number of co-pay card redemptions was calculated during the follow-up period for each co-pay card user Powered by Adheris Health Source: Zitter Health Insights: Co-Pay Offset Monitor, Apr 2015
Pre-Benefit Primary Co-Pay Diabetes C O M M E R C I A L LY I N S U R E D PAT I E N T S ( F O R 3 0 D AY S U P P LY ) Patients using co-pay cards have almost a double in their co-pay per prescription when compared with patients who do not use co-pay cards. With Co-pay Card (n=35,908) Without Co-pay Card (n=62,157) $73 $95 $42 $40 $89 $41 $61 $36 $100 $44 $78 $39 $91 $48 $78 $40 $19 $16 BYDUREON (n=1,450/5,145) BYETTA (n=116/2,728) FARXIGA (n=4,164/5,060) INVOKANA (n=13,975/9,914) JANUVIA (n=7,697/21,963) JARDIANCE (n=859/319) TRADJENTA (n=1,543/4,393) TRULICITY (n=33/31) VICTOZA (n=6,071/12,604) January 2014 June 2014 Patients were enrolled in a 6-month ( January 1, 2-14 to June 30 2014) cohort and were followed for 6 months. Co-pay card users were determined during the enrollment period and the number of co-pay card redemptions was calculated during the follow-up period for each co-pay card user Powered by Adheris Health Source: Zitter Health Insights: Co-Pay Offset Monitor, Apr 2015
Where do savings cards fit in today? What do they actually do? Reduce patients out-of-pocket costs What influences a patients out-of-pocket costs today? Formulary status High deductible plan designs Multiple therapies What can happen when out-of-pocket costs are too high? Higher abandonment rate Lower adherence rate Greater therapeutic switching
Where do savings cards fit in today?
Designing a Savings Card Program What types of things should I be thinking about? 1. What patient needs are you trying to address? 2. What offer(s) might address that need? 3. What is the best channel mix? (point of care/sale, web, etc) 4. How will you determine whether the need was met? 5. What are your competitors doing? 15
What are you PATIENTS solving for? If access barriers are the problem, is improved access the solution? Do patients want a $0 card or reliable and affordable access Is your value proposition real or perceived? How do patients define access? Savings Cards Educational Materials SAVE NOW $0 Co-Pay BIN: PCN: Group: ID: OR Adherence Solutions Access Solutions Pull-through Solutions Reimbursement Support Benefit Verification
Are you providing VALUE or just [$0] cards? This chart shows: 1. $25 co-pay establishes 80% product use 2. $12 co-pay increases use to 97% Do Drs know the actual co-pay in advance? Drs want reliable and affordable access Price elasticity of demand Product for vasomotor symptoms Physician Responses Patient copay/out of pocket cost % of patients expected to be prescribed No coupon $ 25.00 80% With coupon $ 12.50 97% No coupon $ 50.00 23% With coupon $ 25.00 67% No coupon $ 75.00 30% With coupon $ 37.50 53% No coupon $ 210.00 4% With coupon $ 105.00 16% No coupon $ 360.00 7% With coupon $ 180.00 9% Source: Research conducted by Medical Marketing Economics, LLC
Understand the Relevant Challenges Patient Considerations How many different meds are patient s taking? What are the avg. co-pays for each? Lifecycle Considerations Are you a launch brand or a mature brand? What are your goals? Formulary Considerations How strong is your coverage? What s your average co-pay? Market Considerations How many other branded/generic products are there? What are your competitors doing?
Where do access challenges exist? Providers Office Providers Office Awareness Trial Usage Patients Pharmacies Abandonment Substitution Retention/Adherence Formularies Pharmacies Formularies Tier Status Co-Pay Deductibles
How patients needs differ by channel? Rep Delivered Pharmacy Source: PM360 Feb 2015/Chris Dowd PSKW/ Channel Selection: The Second Step to Successful Co-Pay Programs
Summary Healthcare industry is changing significantly The role of savings cards has evolved Worsening access restrictions for patients More holistic access solutions benefit patients Align channel strategies with patients needs