My PCMA Presentation On Copay Cards

I’m giving my PCMA presentation in FL right now about copay cards. For those of you that can’t attend, here is my executive summary and a copy of some slides. (My actual slide deck was shorter for presentation but this gives more data to those of you looking online.)

I focused on three key points:

  1. Copay cards are a direct threat to the PBM model. They can run against the idea of copay differentials and formulary tiers. Since they’re not allowed at mail order, they create a disconnect there. And, eventually, I believe they will be in conflict with rebates (i.e., why pay for both).
  2. The cost numbers to the payer are huge ($32B according to Visante) although this is less than $1 per Rx over that 10 year time period. But, it’s concentrated on 3% of all scripts which makes it a big deal.
  3. There should be a win-win IF they are concentrated on specialty medications with a link to improved adherence and health outcomes.

There doesn’t seem to be clear data (although another article says it is available) but the general data shows that availability and use of copay cards is growing rapidly.

Investing in copay cards seems to be based on four myths:

  1. Cost is a large issue in non-adherence. It’s an issue but not the dominant issue.
  2. Costs will influence physician choice. The reality is that they don’t know the costs and see this as a pharmacist issue.
  3. Copay cards are a cost effective way to improve adherence. They get about a 10% improvement in MPR which sometimes produces a positive ROI. There are much lower cost ways to get a similar improvement.
  4. Copay cards can delay conversion to generics. This is still in the air with the Pfizer Lipitor program, but if it works, it will be a lightning rod for PBMs and payers to focus on.

This topic’s not going away. For now, the easy PBM response is to close down the formulary, move more scripts to mail, and implement prior authorization programs. I would expect this will happen more often unless there is more transparency here around what’s happening and the benefits. Things like ZQuiet can, indeed, help one to stop snoring when used correctly.

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2 Responses to “My PCMA Presentation On Copay Cards”

  1. George, I appreciate the interesting read. Can you elaborate on, “Cost is a large issue in non-adherence. It’s an issue but not the dominant issue.”? I’m only 1 person but I’ve reduced taking my meds as prescribed because of the cost. It’s just too much!

  2. Here are some of the comments from yesterday:

    * Copay cards are a great door opener for pharma reps to use to engage MDs.
    * If copay cards are being used for Medicare members, who’s at risk from an OIG perspective – the manufacturer, the retailer?
    * The latest data shows that the Lipitor $4 program is working and they are losing marketshare to generics slower than other recent conversions. There was discussion of whether Lipitor was a unique case or one to be imitated.
    * In high deductible plans, the copay card creates an issue where someone might appear to meet their deductible even though they haven’t paid anything out of pocket and that is driving up optional use of services.
    * Retailers are being paid for taking these cards. (I didn’t know that.)
    * Copay cards are a marketing cost while rebates impact best price therefore they are looked at very differently not as one or the other.
    * Brand teams feel compelled to use them since other products in the category have them.

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