`
`MAGAZINE
`
`EDITORIAL
`
`RESOURCES
`
`SUBSCRIBE
`
`ADVERTISE
`
`INDUSTRY EVENTS
`
`CONTACT US
`
`(cid:30)
`
`(cid:173) (cid:172) (cid:227) + (cid:177)
`
`Copay programs’ increased value to
`manufacturers is matched by rising
`criticism
`
`January 15, 2014
`
`Despite proven medical value, coupon and copay offset programs
`continue to draw fire from insurers; meanwhile, will the programs
`extend to ACA insureds?
`
`Suzanne Shelley, Contributing Editor
`Coupon or copay-offset provisions are
`aimed at the “out of pocket” (OOP)
`expenses of commercially insured or
`cash-paying patients. When such a
`discount program is used, the drugmaker
`pays the differential between what the
`patient’s insurance plan will pay for that
`drug, and the wholesale price plus
`dispensing fee paid back to the
`pharmacy. The goal is to ensure that the patient’s final OOP cost is capped by the
`dollar figure offered by the coupon or copay-offset program. “When a patient can use
`a coupon or copay-offset card to pay a lower rate than a top-tier copay, they are
`much more apt to fill that prescription,” says Devin Paullin, EVP at Physicians
`Interactive (Marlborough, MA).
`
`Coupons and copay-offset programs are currently available for nearly 400 branded
`products, with the majority being for chronic conditions for which drug treatment
`could be expected for several months or more and can easily cost hundreds if not
`thousands of dollars per month.
`
`In one study of more than 10 million prescriptions for over 5 million patients,
`researchers found that when patients had copays of $50, their prescriptions were
`three times more likely to be abandoned at the pharmacy than when there were no
`OOP costs, and over twice as likely to abandon the prescription when they had a
`copay of $25. [1]
`
`Today, a confluence of factors is driving the deployment of copay-offset programs.
`One big driver that has made many medications less affordable for financially
`strapped patients is tier creep—“whereby Tier 2 drugs no longer carry a $25 copay,
`but a copay closer to $35–$75—resulting in lower medication adherence,” says Chris
`Dowd, SVP for PSKW (Bedminster, NJ).
`
`Most Popular
`1. Court case to decide who controls
`access to pharma traceability data
`
`2. Deloitte and Cardinal Health team
`up for patient support services
`
`3. QPharma brings a new CRM to life
`sciences
`
`4.
`
`Lash Group moves specialty-
`pharmaceutical services from ‘high
`touch’ to ‘smart touch’
`
`5. Elpro offers a unit-dose-level
`temperature indicator for last-mile
`tracking
`
`DIGITAL EDITION
`
`Copays and the copay differential between tiers continue to grow. In 2012, copays for
`retail pharmacy generic and traditional brand prescriptions grew between 10% and
`13% while specialty copays grew by 26% (from $84 to $106 average for a 30-day
`supply), in an effort to keep pace with the rapidly increasing cost of specialty drugs,
`according to the Pharmacy Benefit Management Institute (PBMI; Plano, TX).
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 1 of 8
`
`ACRUX DDS PTY LTD. et al.
`
`EXHIBIT 1626
`
`IPR Petition for
`
`U.S. Patent No. 7,214,506
`
`
`
`(cid:48)
`
`MAGAZINE
`
`EDITORIAL
`
`RESOURCES
`
`SUBSCRIBE
`
`ADVERTISE
`
`INDUSTRY EVENTS
`
`CONTACT US
`
`(cid:30)
`
`(cid:173) (cid:172) (cid:227) + (cid:177)
`
`Copay programs’ increased value to
`manufacturers is matched by rising
`criticism
`
`January 15, 2014
`
`Despite proven medical value, coupon and copay offset programs
`continue to draw fire from insurers; meanwhile, will the programs
`extend to ACA insureds?
`
`Suzanne Shelley, Contributing Editor
`Coupon or copay-offset provisions are
`aimed at the “out of pocket” (OOP)
`expenses of commercially insured or
`cash-paying patients. When such a
`discount program is used, the drugmaker
`pays the differential between what the
`patient’s insurance plan will pay for that
`drug, and the wholesale price plus
`dispensing fee paid back to the
`pharmacy. The goal is to ensure that the patient’s final OOP cost is capped by the
`dollar figure offered by the coupon or copay-offset program. “When a patient can use
`a coupon or copay-offset card to pay a lower rate than a top-tier copay, they are
`much more apt to fill that prescription,” says Devin Paullin, EVP at Physicians
`Interactive (Marlborough, MA).
`
`Coupons and copay-offset programs are currently available for nearly 400 branded
`products, with the majority being for chronic conditions for which drug treatment
`could be expected for several months or more and can easily cost hundreds if not
`thousands of dollars per month.
`
`In one study of more than 10 million prescriptions for over 5 million patients,
`researchers found that when patients had copays of $50, their prescriptions were
`three times more likely to be abandoned at the pharmacy than when there were no
`OOP costs, and over twice as likely to abandon the prescription when they had a
`copay of $25. [1]
`
`Today, a confluence of factors is driving the deployment of copay-offset programs.
`One big driver that has made many medications less affordable for financially
`strapped patients is tier creep—“whereby Tier 2 drugs no longer carry a $25 copay,
`but a copay closer to $35–$75—resulting in lower medication adherence,” says Chris
`Dowd, SVP for PSKW (Bedminster, NJ).
`
`Most Popular
`1. Court case to decide who controls
`access to pharma traceability data
`
`2. Deloitte and Cardinal Health team
`up for patient support services
`
`3. QPharma brings a new CRM to life
`sciences
`
`4.
`
`Lash Group moves specialty-
`pharmaceutical services from ‘high
`touch’ to ‘smart touch’
`
`5. Elpro offers a unit-dose-level
`temperature indicator for last-mile
`tracking
`
`DIGITAL EDITION
`
`Copays and the copay differential between tiers continue to grow. In 2012, copays for
`retail pharmacy generic and traditional brand prescriptions grew between 10% and
`13% while specialty copays grew by 26% (from $84 to $106 average for a 30-day
`supply), in an effort to keep pace with the rapidly increasing cost of specialty drugs,
`according to the Pharmacy Benefit Management Institute (PBMI; Plano, TX).
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 1 of 8
`
`
`
`Read the September/October 2017 Issue now
`It's Free!
`
`Industry Events
`Global Regulatory Submissions Standards
`
`EU GDPR Bootcamp for Life Sciences
`
`3rd Annual Mobile & Digital Platforms
`Summit for Life Sciences
`
`6th Annual Pharmacy Benefit Compliance
`Congress
`
`4th Annual Global Compliance Congress for
`Life Sciences
`
`GTN 2017
`
`9th Annual Federal Pricing and Reporting
`
`Commercial Data Insights 2017
`
`Bio/Pharma Forum on Cannabis-Based
`Science & Medicine
`
`Drug Pricing Congress
`
`View All Events
`
`Tighter economic conditions and competitive pressures from other in-class products
`are also driving demand: Manufacturers are realizing that “remaining competitive in
`their respective markets if other products in the class already offer copay programs
`is an important factor,” notes Tracy Foster, president of Lash Group, an
`AmerisourceBergen Consulting Services company (Charlotte, NC).
`
`Pharma marketers have a variety of resources for managing copay-offset programs.
`Dedicated vendors include PSKW, Physicians Interactive, Opus Health (a unit of
`Cegedim, Bedminster, NJ), Trialcard (Cary, NC), Lash Group (Charlotte, NC, a unit of
`AmerisourceBergen Consulting Services), Triplefin (Scottsdale, AZ; now a unit of H.D.
`Smith Medical Solutions), McKesson Patient Relationship Solutions (Scottsdale, AZ),
`Medimedia Health (Yardley, PA) and QPharma (Morristown, NJ). Various copay-
`assistance programs are available from the many operators of patient assistance
`programs; and vendors of consumer-oriented, retail patient services such as Catalina
`Health (now a unit of Adheris) and Inmar, Inc. (Winston-Salem, NC).
`
`Formulary fight
`Where the insurance industry cries foul is with the longstanding argument that the
`very existence of these copay programs undermines the formulary-tier-designation
`efforts that are so strenuously negotiated with drugmakers. This has the potential to
`undermine the insurer’s bottom line in two ways: (1) By allowing physicians to
`prescribe outside the tiered formulary system, thus forcing insurers to reimburse for
`more costly branded drugs when cheaper, on-tier drugs (both branded and generic)
`are available, and (2) by denying insurers rebates (contracted with drugmakers as
`part of the tier-designation negotiations) that might have been available had an on-
`tier therapy been prescribed. The formulary model is a key cost-containment
`initiative used by payers.
`
`“With these offsets, some brand teams who might never be able to win a preferred
`formulary bidding process can get directly to the patient and pay no rebate to the
`insurer, which changes the balance of power in the negotiating process,” says Mason
`Tenaglia, managing director at Amundsen Group (Burlington, MA).
`
`A 2011 white paper by the Pharmaceutical Care Management Assn. (PCMA;
`Washington, DC) set off alarm bells for many industry observers by stating that drug
`coupons and copay-offset programs “could raise prescription drugs by $32 billion
`over the next decade,” and offering a stinging indictment of the pharma industry for
`pursuing such subsidy programs.
`
`“Many payers—including Express Scripts as a PBM—while supportive of programs to
`facilitate patient access for high-cost specialty drugs, are not supportive of these
`programs as a mechanism to undermine formulary placement,” says Kevin Cast, VP,
`global pharmaceutical business development, at United BioSource, an Express Scripts
`company (Blue Bell, PA). “This incurs additional expenditures with no additional
`health benefits for the patient.”
`
`In response, Cast says, “Some payers are allowing members to fill their prescriptions
`only at pharmacies that don’t accept copay cards; another payer tactic to counter
`their use in competitive drug classes is to remove those medications from the
`formulary altogether.”
`
`However, coupon advocates say that the payers’ portrayal of copay-offset programs
`is not always fair or accurate. “The problem with the PCMA paper, which generated a
`lot of media attention, is that it is not backed up by a single analysis of actual data in
`any therapeutic class,” says Tenaglia. “There are studies that show that the combined
`medical and pharmacy costs for such debilitating conditions as cancer,
`rheumatology-related disorders and multiple sclerosis can actually be reduced when
`patients remain on therapy. And it is clear in all those classes that copay support
`increases adherence.”
`
`After conducting several years of empirical analysis through a variety of longitudinal
`studies, the Amundsen Group asserts that copay-offset program usage is not
`correlated with lower generic utilization in any of the major drug classes, and points
`out that most of the money invested by US brand teams goes into offset programs
`that are aimed at the extremely high-dollar-value specialty, biologic and orphan
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 2 of 8
`
`
`
`drugs—such as TNF inhibitors, therapies for multiple sclerosis, HIV, Hepatitis B and
`C, oral oncology products and so on—for which there are no alternatives available
`(generic or otherwise), and for which the OOP cost for patients can easily run into
`hundreds or thousands of dollars per month.
`
`“Insurers can argue that these offset programs drive patients to use more costly
`branded drugs (in lieu of cheaper branded options or generics), but studies have
`shown that more than 40% of the time, in the absence of a copay-offset program, if
`the patient cannot pay the OOP expenses, they won’t switch to a cheaper drug—they
`will simply forgo the medication,” says Mick Kolassa, managing partner of Medical
`Marketing Economics (MME) LLC (Oxford, MS). “The insurance industry will end up
`losing considerably more money over the long run, in terms of covering related
`medical expenses that arise when the patients don’t control their conditions through
`the use of medication.”
`
`Even the Pharmacy Benefit Management Institute conceded this point. In its “2012
`–2013 Prescription Drug Benefit Cost + Plan Design Report,” the organization writes:
`“Plan sponsors must develop effective strategies beyond higher cost-sharing for
`managing specialty drug spend given the detrimental effect that further copay
`increases for specialty drugs are likely to have on medication adherence.”
`
`“We’ve done the analysis across many therapeutic classes, and there is no clear data
`that shows that there is higher branded drug utilization in classes that have generics,
`but this is what the insurance continues to assert,” adds Tenaglia of the Amundsen
`Group.
`
`According to a 2013 study published in the New England J. of Medicine, less than 8%
`of copay assistance cards or coupons are for products for which there is a generic
`available. [2]
`
`Today, pharmacy spending currently accounts for roughly 10% of healthcare costs.
`Supporting the idea that prudent use of drug therapies pays its own dividends, a
`recent Congressional Budget Office study [3] notes that every dollar spent on
`pharmaceuticals saves two dollars in overall healthcare costs. “The converse of this is
`that every dollar not spent on pharmaceutical interventions costs the industry $2 in
`healthcare costs, and the numbers used in that CBO study were very conservative,”
`says Kolassa. He asserts that copay assistance is actually “helping to subsidize the
`health insurance industry” itself.
`
`Meanwhile, the claim that copays exist primarily to influence prescribers, is dubious
`at best. “A coupon would not likely be the reason any doctor would write a
`prescription,” says Paullin of Physicians Interactive. “But once the physician has
`selected the therapy, the coupon can help increase both affordability and adherence
`for the patient.”
`
`“Even payers, who are largely critical of such programs, understand that affordability
`impacts adherence,” says Foster of The Lash Group.
`
`Coupons under the ACA
`While Pharma may not like the situation, it has long accepted that patients in
`Medicare, Medicaid, Veterans Administration (VA) programs or other federal
`healthcare programs are not eligible to use pharma coupons, copay-assistance cards
`or similar subsidy-type programs, because they are viewed as illegal inducements
`that have the potential to violate the federal anti-kickback statute (AKS).
`
`But a far more grey area has been the lingering question of whether or not coupons
`and copay-offset programs would also be barred from being used in the health
`exchanges established by the Patient Protection and Affordable Care Act (ACA, or
`Obamacare), which—according to one side of the argument—could be construed as
`federal programs, given that there is some level of federal subsidy involved in the
`exchanges.
`
`Specifically, all stakeholders have been holding their breath, waiting to see whether
`or not previously uninsured patients, now finally insured through healthcare
`exchanges under the ACA, would be allowed to use coupons and copay-offset cards
`
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 3 of 8
`
`
`
`that are aimed at making certain medications more affordable. As of press time, the
`answer remains far from clear.
`
`In late October, Kathleen Sebelius, HHS Secretary, attempted to resolve this question
`in a letter to Congressman Jim McDermott (D-WA), but critics of the copay
`assistance programs say that her characterization of the situation was both
`misguided and misinformed and will have no legal standing over the long run.
`
`Specifically, the Sebelius letter says that HHS does not consider qualified health plans
`purchased through the ACA insurance exchanges to be “federal healthcare programs”
`for the purpose of the federal anti-kickback rules.
`
`“Given the recent conflicting guidance from HHS and CMS around Qualified Health
`Plans, manufacturers should be very cautious with their approach to providing cost-
`sharing assistance to patients enrolled in these plans,” says Scott Dulitz, VP, product
`support, at UBC. Mark Merritt, president and CEO of the PCMA, went farther in a
`statement: “Now regulators need to take the next step and formally determine what
`everyone already knows: That federal anti-kickback laws apply to the ACA.”
`
`Some in Congress agree. Senator Chuck Grassley (R-IA) wrote to Sebelius and the
`Dept. of Justice, saying it was “extremely disturbing” that the HHS Secretary is
`“intentionally attempting to strip away these vital protections by administrative fiat.”
`
`“It is unclear exactly who has the authority to declare whether exchange plans
`purchased with federal subsidies are federal healthcare programs,” says Kevin
`McAnaney, a Washington, DC-based attorney and former HHS executive who
`specializes in anti-kickback and Stark laws. He notes that the only agency with
`jurisdiction over the AKS “would appear to be the Dept. of Justice (DOJ),” saying:
`“While HHS has regulatory authority to create safe harbors for conducts that
`otherwise might violate the AKS statute, nothing the Sebelius letter said is binding
`and HHS can reverse their position at any time, and DOJ can reverse it through
`rulemaking.”
`
`Proponents of drug coupons and copay-offset programs say that it is a cruel twist of
`fate that previously uninsured patients—once enrolled in one of the ACA health
`exchanges—would still be denied access to the coupons and copay offsets that are
`already available to patients with private insurance.
`
`“How do you tell patients in the ACA that they are not entitled to the same discount
`coupons that aim to make certain drugs more affordable as patients who already
`enjoy private-sector insurance plans are entitled to?” says Derek Rago, VP and GM of
`McKesson Patient Relationship Solutions. “Under ACA, it should be all about trying to
`finally provide uninsured Americans with some form of health insurance, with the
`ultimate goal of improving patient outcomes.”
`
`And Sebelius’ position has possible political significance, as well. The Obama
`administration “cannot come out and say that the exchanges operated under the ACA
`are ‘a federal program’—people would scream ‘socialized medicine’ or ‘a government
`takeover of healthcare,’” says Kolassa of MME. “It was especially important for
`Sebelius to reiterate that the ACA establishes a broad private/commercial insurance
`market—not a government program—and thus, by definition, the potential to violate
`the AKS statute would not apply.”
`
`“If that distinction were to ultimately be reversed, the issue will become so much
`bigger than just copay cards alone,” he adds.
`
`Best practices in program development
`While they may be under fire, it’s clear that coupon and copay-offset programs are
`here to stay. Experience in the early years has brought to light several ways in which
`drugmakers can make these programs as effective and valuable as possible, for both
`the pharma brand team and the patient.
`
`At the end of the day, the price at the pharmacy counter is not the sole motivator for
`patients to be healthy and stay on therapy, and simply lowering the cost of
`medications does not necessarily provide enough of a support mechanism to improve
`compliance and long-term health outcomes
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 4 of 8
`
`
`
`“It’s important for brand teams to recognize the different types of barriers that can
`lead to low drug compliance,” adds Rago of McKesson. He notes that financial
`barriers can be addressed by coupons and copay-offset programs, and clinical
`barriers—related to, say, side effects or lack of efficacy—can be addressed through
`greater physician and pharmacy support and branded and unbranded educational
`materials provided by the drug manufacturer and other entities.
`Even more vexing, says Rago, are the so-called “cognitive challenges” that must be
`overcome in order to ensure maximum compliance with the drug regimen. “These
`include such issues as the patient not truly understanding the severity of the disease
`(which is especially common for chronic conditions such as high blood pressure or
`high cholesterol that are asymptomatic), not understanding the role of the
`medication or the importance of taking the full course of drugs according to their
`label instructions,” he says.
`
`Industry experts in patient-assistance programs agree: The goal of any brand team
`should be to offer more than just the copay-offset card itself. A range of other
`support tools such as refill reminders, educational outreach to the copay-assistance
`program via patient opt-in mechanism and followup from call centers will help the
`patient get stay on therapy and experience sustained improvements in outcomes. [4]
`
`With the understanding that patients voluntarily opt in to copay programs, the
`pharma industry benefits by having a direct link to the patient. With this,
`manufacturers can provide targeted, actionable information right from the
`beginning, to make sure patients understand why they are being prescribed the
`medication, to explain the side effects and provide tips for managing them, to stress
`the importance of taking the entire course of treatment and so on.
`These can be as simple as sending the patient a reminder message (via text or email)
`once the prescription is submitted electronically, to remind them to pick up the
`prescription, or to bring their copay-assistance card if necessary.
`
`“With just three to five strategically worded questions at the opt-in stage, the brand
`team can accurately characterize which patients are highly likely to be adherent and
`which are not,” says Rago of McKesson, and that can help the team to customize the
`patient-support outreach that follows once the patient starts the medication.
`
`Advanced programs will use such information to create personalized and customized
`messages, based on what type of information the patient wants to see, in the
`preferred format, from the onset of being in the program, to help them get past some
`of the hurdles and stay on therapy.
`
`There is no one-size-fits-all approach here, says Rago of McKesson. For instance,
`higher-touch models are appropriate for complex diseases or specialty medications
`with complicated administration requirements. For these cases, it is often
`appropriate to establish contact centers with live patient-support representatives
`“who can have a rich, two-way dialogue with patients who may be likely to fall off
`therapy and have other barriers to adherence,” he says. Since high-touch programs
`always have higher costs associated with them, their ROI must be justified brand by
`brand.
`
`Apply analytical rigor
`Pharma companies already devote considerable effort to negotiating rebate terms to
`attain preferred status or access through contracts with managed care companies.
`According to Amundsen Group’s Tenaglia, they need to apply the same level of
`business sense and analytical rigor when it comes to designing and deploying copay-
`offset programs—to project the actual costs, analyze the ROI of the effort, and
`understand the impact of the program on patients.
`
`Again, offering a one-size-fits-all approach is not an option. Rather, it’s important to
`deploy these programs where they are needed most, not necessarily across the
`board, using both geographic and brand considerations. “You want to design copay
`programs that make sense—ones that save patients who might abandon their
`prescription and ones that will not subsidize patients who would have filled their
`prescription anyway,” says Tenaglia. “Savvy brand teams will analyze how costs
`associated with copay-offer programs differ in different regions, and analyze those
`
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 5 of 8
`
`
`
`against costs already associated with rebates provided under existing managed-care
`contracts and use this insight to guide program development.”
`
`For instance, if a given insurance provider is dominant in a given region, and you’ve
`already paid significant rebates to lower the patient’s drug cost through that
`formulary program, it does not make sense to heavy up on copay cards in that region
`at the same time, he says.
`
`Tenaglia suggests that brands can minimize erosion of profit margin by focusing on
`allocating offset cards to those geographic areas with the greatest price sensitivity
`(where such assistance really matters)—to support patients who may otherwise
`simply forgo treatment without such support. For instance, when brand teams
`conduct studies to analyze anonymous patient longitudinal data (APLD), they can drill
`down even more precisely into patient price sensitivity, at both the initial
`prescription pickup and at each subsequent refill. These data can help program
`designers to identify critical threshold values for OOP costs, after which patients will
`start to abandon their prescriptions, and tailor their programs accordingly.
`
`“This level of analytical rigor currently only happens in a handful of companies, but it
`is necessary, because in some cases, copay-offset programs may end up costing more
`than the rebates given to retain preferred tier status,” he says. “When companies
`don’t get this right, they end up paying for the same drug three times—through
`rebates to managed care, through offsets to the patients, and by incentivizing the
`reps to tell doctors about the copay-offset offering.”
`
`The funds devoted to copay and offset
`programs can be a vital part of overall
`pharma marketing budgets. “Because
`brand teams can measure and manage
`these programs, they can be as effective
`as any major promotional avenue at a
`fraction of the cost,” points out Dowd of
`PSKW. At Physicians Interactive, Paullin
`notes that, “Another important advantage
`of e-coupons is that they provide a
`mechanism for small and mid-tier
`pharmaceutical companies to deliver
`cost-savings programs to physicians all
`over the US without the burden of a
`
`Fig. 2. PSKW’s analysis of claims data shows a “halo
`effect” on prescribers who will increase scrips for a
`drug with a coupon, regardless of actual use of that
`coupon. Credit: PSKW
`
`costly sales force.”
`
`Copay-offset programs are equally valuable at launch, and later in the product
`lifecycle, to help speed market penetration and make new drugs more affordable
`during the initial period when a new medication would likely have a Tier 3 copay
`before the manufacturer can establish the contract with the drugmaker.
`
`PSKW’s Dowd notes that there is a “halo effect” with physicians simply because of the
`existence of patient support. Non-coupon patients (i.e., patients whose plans do not
`have high copays) are more likely to be prescribed a drug that the physician is aware
`of through the existence of the program. (Fig. 2).
`
`The e-prescribing environment
`Traditionally, coupons were paper documents, often handed over by the rep during a
`physician visit, along with samples. Sometimes the physician remembered that a
`coupon exists for a prescription; sometimes not; sometimes, the paper coupons are
`locatable in the sample closet; sometimes not. These logistical difficulties are being
`addressed both by e-prescribing and electronic health record (EHR) systems now in
`wider use by physicians, and by online sample closets where physicians order
`samples directly from manufacturers.
`
`With the growth of EHR systems, the capability of creating an electronic coupon,
`accessible (or present) at the point of prescribing, is on the rise. Savvy consumers are
`also aware of online sites that aggregate coupons from many manufacturers.
`
`The home run in this environment is when an electronic coupon is coupled with the
`
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 6 of 8
`
`
`
`electronic prescription, and both the patient and physician are aware of it at the
`point of prescribing. But getting there is not a simple task. PSKW’s Dowd notes that
`the EHR market is highly fragmented (there are estimates of more than 500 EHR
`vendors) with varying degrees of system interoperability. He notes that all
`stakeholder groups must working to address these challenges in order to optimize
`the capabilities of e-coupon programs.
`
`At Physicians Interactive, Devin Paullin notes that “Clinicians are very open to
`receiving select services from pharma manufacturers within their mobile devices and
`EHR—if it adds value and is relevant to their workflow and to the delivery of quality
`care, they will use it.” A recent Physicians Interactive study of 2,300 physicians, nurse
`practitioners and physician assistants revealed that medication vouchers and
`coupons were “the most requested pharma resources to have access to directly
`within the EHR software.”
`
`Some EHR vendors have open access to marketing information from manufacturers,
`and inclusion of a coupon program is fairly straightforward. Another evolving channel
`is online drug information databases offered by vendors like PDR Network, Epocrates
`and others; prescribing information for drugs can be accompanied by a discreet
`reminder that a coupon is available. The watchword in all this is not to interfere with
`the physician’s “digital workflow” of navigating an EHR system. Properly designed, the
`electronic coupon is a welcome component; poorly designed, it becomes an
`irritation.
`
`“We’re still in the first generation of integrated products that will improve adherence
`and outcomes, and we are still learning, but—as an industry—we’re all approaching
`this very responsibly (in terms of clinical, legal and regulatory requirements) and
`there are rules in place in all of these EHR systems to minimize commercialism,” says
`Paullin.
`
`References
`[1] Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH,
`Capewell, Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000;
`N Engl J Med, 2007).
`[2] Joseph S. Ross, MD, and Aaron S. Kesselheim, MD, JD, MPH, N Engl J Med 2013;
`369: 1188–1189, September 26, 2013, DOI: 10.1056/NEJMp1301993).
`[3] Offsetting Effects of Prescripton Drug Use on Medicare’s Spending for Medical
`Services, www.cbo.gov/publication/43741.
`[4] Shelley, S., “Pharma Struggles to manage the complexity of its Patient Assistance
`Programs,” Pharmaceutical Commerce, March/April 2013, p. 1.
`
`Posted in Brand Marketing / Communications | Tagged JANUARY/FEBRUARY 2014
`
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 7 of 8
`
`
`
`WE RECOMMEND
`
`Clinical Operations
`◾ Clinical operations are heading for a unified digital platform, but how fast?
`
`Latest News
`◾ Woodfield Distribution offers 3PL-based DSCSA compliance services
`
`Cold Chain Focus
`◾ Honeywell bids to be a player in healthcare logistics
`
`Latest News
`◾ FDA moves to withdraw Opana opioid from the market
`
`Clinical Operations
`◾ Making a business of ‘compassionate use’ drug distribution
`
`About Us
`
`Editor in Chief
`
`Contact Us
`
`Advertise
`
`Terms of Use
`
`Privacy Policy
`
`© 2017 Pharmaceutical Commerce, Property of Healthcare Commerce Media Corporation. All Rights Reserved.
`Custom Website Design.
`
`
`
`http://pharmaceuticalcommerce.com/brand-marketing-communications/copay-programs-increase...
`
`10/31/2017
`
`Page 8 of 8
`
`