1. Co-pay accumulator programs. Manufacturer co-pay assistance programs are an important source of financial assistance for patients who face high out-of-pocket costs for their medications. In most plans, co-pay assistance programs are counted toward a member’s deductible and/or out-of-pocket maximums. As a result, members meet their plans’ deductibles and out-of-pocket maximums more quickly, although their cash outlays are in reality much lower. Pharmacy benefit managers, particularly those that own specialty pharmacies, are increasingly offering programs-referred to as co-pay accumulator or optimization-that track a member’s actual out-of-pocket costs and ensure that co-pay assistance is not applied to a member’s deductible and out-of-pocket maximums. Staying ahead of this growing trend and developing strategies to quantify and mitigate the impact is imperative for manufacturers, especially as it relates to annual sales forecasting considerations.
2. Dynamic payer segmentation. Approaches to payer segmentation have traditionally involved a retrospective look at payer behavior when it comes to formulary management and inclusion of new drugs. The changing market access landscape demands that payer segmentation approaches evolve as well. Payer segmentation is increasingly taking into account factors that may better predict payer behavior in the future. These factors include the types of acquisitions the payer is making, the capabilities it is adding, and the partnerships into which it is entering. Understanding where payers are going-as much as where they have been-will lead to better engagement with customers to optimize market access opportunities.
3. Supply chain model disrupters. New market entrants in drug distribution may present opportunities to drug companies. Given the embrace of direct-to-consumer offerings, the entrance of companies like Amazon can begin to transform the drug supply chain model and the pharmacy experience. To prepare, manufacturers should review their channel strategies and the impact of different disruption scenarios. Strategic partnerships with new market entrants could enable some manufacturers to gain an early competitive advantage.

To receive more expert insights on the latest healthcare news, connect with us.