Addressing Specialty Drug Access and Affordability Issues

EDITOR’S NOTE: The author is Vice President, Product & Market Development, RxCrossroads by McKesson.

Specialty drugs have emerged as important treatment options for patients with chronic conditions in many therapeutic areas, including oncology, neurology, and rheumatology. However, there can be significant access and affordability issues with specialty drugs.

Even among patients who can afford their specialty medications, many experience fill delays of up to 30 days due to confusing prior authorization processes. With the complexity of specialty drugs, access is only the first step to impacting patient adherence and outcomes.

Distinguishing Between Access and Affordability

Patients can benefit significantly by having support throughout their treatment journey, starting with access and minimizing financial barriers. When speaking about patient support services, the discussion often revolves around access and hub services for patients. Support service providers help ensure that patients have access to the treatments they need, from onboarding, prior authorizations, and medication benefit investigation to resolution, and patient engagement.

The cost of specialty medications, and the increased adoption of high-deductible health plans (HDHP) have placed a higher financial burden on patients. As out-of-pocket costs increase, patients are more likely to abandon their prescription, despite that their overall health may be dependent on being adherent. As a result, many patients rely on biopharma-sponsored support and co-pay programs to help afford their specialty medications, and stay adherent to the prescribed course of therapy.

Financial offset programs, such as co-pay cards, have historically focused on nonspecialty pharmacy products, providing an affordability solution for branded drugs.

When associated with retail pharmacy, co-pay cards are typically handed out at the physician's office or consumers search online for coupons. With the complexity of specialty drug delivery and administration, we have to look at more direct and efficient methods of connecting patients to co-pay programs.

Over the past several years, the industry has begun to shift manual hub services and access program enrollment to technology-driven solutions that are integrated directly into the physician workflow. There is an opportunity now to leverage this connectivity to drive access to co-pay programs as well. For example, as the prior authorization process is conducted and patients are enrolled in patient support programs, having information about co-pay assistance availability ensures that there is an affordability solution.

Using Data to Drive Co-Pay Strategy

Data has been a foundational component to co-pay programs since their inception. In today’s rapidly changing environment, building an intelligent data strategy can better support patients, prescribers, and pharmacies by identifying trends, building behavioral profiles based upon unique characteristics, and allowing for predictive analytics.

RxCrossroads by McKesson is 1 tool that utilizes a data-driven approach. From the initial design of co-pay programs, through their deployment and post-launch optimization, the system leverages machine learning, data scientists and an intelligence monitoring system. RxCrossroads views the launch of these programs as a starting point for deploying our data intelligence.

Technological tools such as PA Reach℠ help maximize the effectiveness of a co-pay program for patients, while supporting the brand strategy and budget. PA Reach℠ addresses prior authorization cost barriers by helping patients enroll and submit claims to a co-pay assistance program so they can access prescribed medication while going through a prior authorization initiation or appeals process.

Leveraging predictive tools to identify and support patients in accumulator plans

As HDHPs become the norm, understanding their impact on patient behavior is critical to optimizing patient support and co-pay outcomes. Additionally, co-pay accumulator programs can significantly impact patients utilizing co-pay assistance programs by not allowing the funds under traditional programs to apply towards patients’ deductibles or out-of-pocket maximums. These plans can particularly affect patients needing specialty medications, which can come at a high cost, and as patients reach co-pay program thresholds, their ability to afford these critical therapies is impacted.

RxCrossroads uses a proprietary Accumulator Predictor Model™ to forecast the potential accumulator impact for more than a dozen chronic/specialty therapeutic categories. The data suggests that nearly 5% of patients may be impacted, which we expect to continue rising in 2020.

Leveraging data to predict a patient’s likelihood of being impacted is only 1 critical element of support. It’s necessary to have ongoing monitoring and support by applying appropriate guardrails to make sure that program benefits are being utilized appropriately for each patient. After patients are identified, the DeductAssist outreach provides education and support to help patients understand what accumulator impact is, and options for medication access.

Providing patient support improves adherence by helping patients through their higher out-of-pocket deductible periods and deters discontinuation due to financial challenges. The data indicates that providing support to accumulator patients results in significantly better persistence than the non-supported accumulator patients (~19.7% at 10 months).

Ultimately, it’s About Providing Better Access to Financial Support Programs

With the cost burden and complexity of specialty drugs, proactively addressing access and affordability is critical to improving patient adherence, and health outcomes. Even though their overall health may be dependent on adhering to their treatment regimen, patients are often forced to make life and death choices based on affordability.

Leveraging integrated co-pay programs can help to overcome these financial barriers, provide an opportunity to highlight program benefits, and integrate patient support. However, price is only 1 piece of the adherence equation.

Simply addressing out-of-pocket costs is frequently not the only solution needed to help remove adherence barriers. Identifying and understanding where and why patients are not adherent to a prescription will help biopharma brands deliver the right support throughout their therapeutic journey.