Patient Affordability

Global Market Outlook on Patient Affordability

Market Value: $1.9 billion (2022E)

The global demand for patient affordability market is expected to grow at approx. 8.9 percent CAGR through 2022–2027

• As patients are aware of the support program in the North American and Western European regions, we see industries focus towards APAC and Eastern Europe regions, thus increasing the demand

• In the developed nations, we can see increase in the usage of technologies, such as telemedicine, wearables, chatbot, etc.

Patient Affordability Market Overview

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 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

• Co-pay 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 accumulator plans

Artificial Intelligence (AI)

• AI is being incorporated to improve patient adherence, as 50 percent patients stopped taking medications within 30 days of treatment. The platform provides real time information and maintains a track of their medication consumption

Industry Best Practice : Patient Affordability

• Companies prefer to work with a mixture of preferred supplier and local/other supplier mix, depending on the geography and service required. This is combined with a project-based approach, considering the small-term requirement for a particular drug or therapy.

• A project-based approach is preferable because of the differentiated requirements in each project, which enables the client to make use of the wide supplier base available

• Poor demand visibility and smaller budgets retain this category to be sourced as a fee-for-service model

• Currently buyers work with multiple suppliers, based on immediate requirement. Most procurement functions are retained as tactical

• The relatively small budget retains the market as a need-based procurement practice. In the next 1–2 years, there would be an increasing trend of larger pharma budgets on patient adherence programs and increasing strategy to drive patient pathway

• This trend is expected to drive larger scales of demand in the market, leading to an evolving supply base that could mature into more structured buy, based on per unit pricing or consolidated buy