Patient Affordability
Market, Supplier, Risk and
Competitive Intelligence

Industry Outlook & Drivers

Global Market Outlook on Patient Affordability

Pharmaceutical companies are increasing their reliance on patient access, affordability, and adherence programs, as they are a cost-efficient way of fulfilling marketing needs and providing marketing managers with insights into physician and patient behavior.

Drivers
• Stringent and changing regulations
• Increasing government support for improving healthcare infrastructure
• The need for reducing healthcare costs
• Increasing volume of claims denials
• High number of private healthcare payers and well-established government payers
• The presence of a large number of healthcare IT companies

Constraints

• Slower adoption rate
• Lack of awareness about the available access opportunities
• Lack of denials management

Patient Affordability Latest Market Trends

Changing regulations in the healthcare sector is advancing the need of electronic data exchange and expanded treatment medical access. The legislation is providing amendments to lower the drug prices and simultaneously, paving the way for the bio-similars and generic drugs.

Five-Tier Plan

• Companies have designed a new pharmacy benefits plan, five-tier plan, where a patient can pay five different amounts of payments, depending upon the drug he/she takes
• Five-Tier Plan: T-1: Low cost prescription drugs, T-2: Medium cost prescription drugs, T-3: High cost prescription drugs, T-4: High cost branded drugs, T-5: High cost branded and specialty drugs. Central US is pushing the payers and patients to use five tier plans

Insurance Landscape Changes

• Post the implementation of Affordable Care Act, the number of uninsured person has come down and is expected to go down further
• Understanding of the reimbursement landscape can help to determine what type of support patients will need, which will reduce out-of-pocket healthcare expenses

Co-pay Accumulators

• Copay accumulators is a novel policy designed by PBMs and insurers to avoid using manufacturer co-pay cards, which will help in excluding copayment liabilities, covered by copay assistance programs. This will enable patients to have access to affordable prescriptions and care
• People with employee sponsored plans and high-deductible health plans are most likely to be in co-pay accumulators plan

Technological Advances

• Interactive Voice Response (IVR), online patient communities are being opted by pharma in order to provide reminders and updates
• This will indirectly improve patient adherence and provide with a wide variety of enrollment opportunities for a trial