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Trialcard Patient Access Programs Deliver. Do Yours? TrialCard Patient Access Programs Deliver. Do Yours? 60% LIFT IN TRX TrialCard Pulse Analytics determines the optimal oer to ensure brand therapy continues as prescribed. 20% INCREASE IN NRx TrialCard Pulse Analytics' study of prescriber behavior, shows that NRx increases in the rst three months of participation in our programs. 60% INCREASE OF SOV TrialCard tele-detailing reaches 60% more target prescribers than traditional sales at just at 10% of the cost. Rx# 1234567 JOHN DOE 123 MAIN STREET, ANYTOWN, USA TAKE 1 TABLET TWICE A DAY 18% INCREASE IN ADHERENCE Patients who utilize co-pay programs from TrialCard CIZPLAN are 18% more adherent to their medications. 3 REFILLS 10% LIFT FOR TARGETED MARKETS TrialCard Pulse Analytics identied high-potential patient opportunities that drive brand lift. [email protected] Solutions powered by Overview A MM&MB Digitalo Publicationok The state of patient access The average consumer benefits from ACA these new specialty drugs can be sky high. One head- “You say, rules increasing the number of zero co-pays on line-grabbing case in point is Sovaldi, the Gilead Sci- ‘Well, if you’re prescription drugs and the availability of more low- ences treatment for chronic hepatitis C that was ap- cost generics, while specialty drug patients see proved in December. The price for each pill is set at spending costs and obstacles rise. Marie Griffin reports $1,000 and the cost adds up to $84,000 for a 12-week $100,000 for course—which is touted as a cure. Gilead has instituted a program called Support Path an oncology that assists “eligible” hepatitis C patients who do not therapy, of have insurance, are underinsured or who otherwise course you’d atient access to pharmaceuticals in 2014 is a need financial assistance to gain coverage for or access tale of two worlds. For the world of the ma- to the drug, according to the company website. expect some Pjority of patients, access has improved mea- The program includes dedicated case managers who services.’ surably. Prescription drug costs are declining and can help patients and physicians with insurance issues, more drugs are available for no out-of-pocket cost, a 24/7 nursing support service line, and the Sovaldi But it didn’t health insurance affordability has increased as a re- Co-pay Coupon Program. “Most patients will pay no matter, sult of the Affordable Care Act (ACA), and seniors more than $5 per co-pay,” according to the site. Gil- regardless of on Medicare are receiving help paying for branded ead is also supporting the non-profit Patient Access drugs when they fall into the “donut hole,” the price Network Foundation, which assists eligible patients in disease state gap in which pharmaceutical costs are not covered by covering out-of-pocket drug costs. or type of the program. The situation is much more complicated, though, Generics and specialty drugs anchor drug.” for the small minority of patients who have condi- price poles —Tony Romito, managing tions requiring specialty medications. On the positive The April “Medicine Use and Shifting Costs of director, Accenture’s Life Sciences Practice side, pharmaceutical companies are investing more in Healthcare” report by the IMS Institute detailed how R&D to develop drugs that will be used by smaller pa- generics, which accounted for 86% of dispensed pre- tient populations. Seventeen new orphan drugs were scriptions in 2013, and no-cost preventative care drugs launched in 2013 and a total of 53 have been launched drove costs down for the average consumer. “Prescrip- over the past five years, in comparison to only 29 in tion drug costs for most patients are actually declin- the prior five years (IMS Institute for Healthcare In- ing, with more than half of all prescriptions costing formatics). less than $5, and 23% now available with zero out-of- On the downside, patients on specialty medications pocket costs,” the IMS Institute reported. 22% are asked to pay a higher proportion of their medi- Americans with insurance picked up 207 million of non-adherent cation costs than other Americans—and the cost of prescriptions without co-pays in 2013, and saved an patients said ‘trying Abandoned prescriptions increase as co-pays increase, to save money’ was a major reason for especially for new claims Percent of claims by co-payment range for new vs. re ll not filling a medication 30 Source: “MedicationAdherence in New America, A National Report Card,” 25 National Community Pharmacists Refill Association 20 15 10 5 0 < $10 $10 - $20 $21 - $30 $31 - $40 $41 - $50 $51 - $100 > $100 New and re ll commercial claims only, days supply ≤ 30, branded products only, 2009 Source: Wolters Kluwer Pharma Solutions mmm-online.com x Copyright 2014 Haymarket Media Inc. 3 Overview A MM&MB Digitalo Publicationok The state of patient access average of $0.63 on each prescription they filled in Estimates of the percentage of patients that is Access 2013 compared to 2012. Women benefitted from new nonadherent varies widely, partly because different barriers are ACA rules on contraceptives, which resulted in the researchers define the term differently. A November share of patients with zero co-pay rising from 20% in 2011 article, “Trouble Getting Started: Predictors of rising for 2012 to 50% in 2013. Primary Medication Nonadherence,” published in patients who Spending on specialty medications, meanwhile, the American Journal of Medicine, set out to measure has averaged 10% growth in the last five years, and primary nonadherence, prescriptions issued electroni- need specialty grew 9% in 2013. Specialty medications accounted cally and filled, but never picked up by the patient. drugs, as for 29% of all drug spending in 2013, up from 23% Researchers found “nearly a quarter of patients given PBMs and five years earlier. As a result, 30% of patient prescrip- a new medication prescription by their doctor did not tion out-of-pocket costs were put toward just 2.3% pick up their initial prescription, results that reflect plan sponsors of prescriptions. Five medical conditions—oncology, slightly higher primary nonadherence figures than employ strict antidiabetes, mental health, respiratory and pain—are previous studies.” In “Medication Adherence in America, A National formularies, Specialty medications Report Card,” a study commissioned by the National prior Community Pharmacists Association, nonadherence authorization accounted for 29% of was studied at a more granular level. Based on a na- drug spending in 2013 tional sample of more than 1,000 adults age 40 and and step edits. older who were taking a prescription medication for a responsible for more than one-third of drug spending, chronic condition, NCPA found that 57% had missed the IMS Institute said. a medication dose over the past 12 months, 28% did Access barriers are rising for patients who need not refill their medication on time, 22% took a lower specialty drugs, as PBMs and plan sponsors increas- dose than prescribed, 20% did not fill a new prescrip- ingly employ such PBM tactics as strict formularies, tion and 14% stopped taking their medication without prior authorization and step edits. Earlier this year, discussing it with a physician. MM&M commissioned a patient survey fielded by Twenty-two percent of the nonadherent respon- WEGO Health using the Truvio mobile research plat- dents said “trying to save money” was a major rea- form and database of health activists. Patients ranked son they did not fill a medication or did not take it cost, distribution and red tape as their three biggest as prescribed. Indeed, the higher the co-pay, the more obstacles. Sixty-two percent said they occasionally likely it is that a prescription will go unfilled (see chart, or frequently dealt with prior authorization or were previous page). asked to try cheaper alternatives before gaining access to the more costly drugs their doctors had prescribed, Pharma companies tackle adherence a tactic called step edits. issues There are many ways to improve adherence. Medica- Poor adherence remains costly issue tion reminders can be sent to patient by text message The cost to the healthcare system of patients who do or phone, or patients can use a medication reminder not take their prescriptions or do not take them cor- mobile app or use a simple plastic pill box with slots rectly, known as nonadherence, has been estimated by for each day of the week. various sources from slightly over $100 billion to al- Pharmaceutical companies are addressing adher- most $300 billion annually. ence issues when they formulate medications or pre- Progress is being made. For example, the IMS In- pare packaging for them. The classic wheel-shaped stitute reported that “medication adherence among package for birth control pills with the days of the large populations of patients with three of the most month displayed is one example of the packaging prevalent chronic diseases—hypertension, hyperlipid- solution. emia and diabetes—has improved since 2009 by about Formulating medications so that they can be tak- 3%.” The institute also noted that out-of-pocket medi- en less often—once a day rather than four times or cation cost “is increasingly less of a factor” contribut- once a month rather than weekly—has been found ing to nonadherence for chronic conditions that can to improve both compliance and persistence in pa- be treated with generic medicines. tients. Eight of the new drugs launched in 2013 were mmm-online.com x Copyright 2014 Haymarket Media Inc. 4 Overview A MM&MB Digitalo Publicationok The state of patient access formulated for easier dosing, the IMS Institute noted, lined the large gap between what consumers would “including an epinephrine auto-injector that talks the like from pharma and what they get.
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