More than a discount: How intelligent copay programmes are redefining patient access

As rising out-of-pocket costs and the growing complexity of insurance design continue to challenge patient access, the pharmaceutical industry’s traditional copay models are being stretched to their limits. This has created a critical tension for manufacturers: how to protect patient access to therapy while simultaneously managing gross-to-net performance and mitigating financial leakage.

In this Q&A with Brian Laird, president of patient services at EVERSANA, pharmaphorum explores how a more dynamic, data-driven approach to copay is redefining affordability and creating a new standard for balancing patient support with sustainable financial strategy.

Q. We often hear that pharma copay programmes have moved beyond being simple transactional services. What are the major market forces driving this evolution and turning them into strategic financial tools for manufacturers?

Brain Laird: The driver here is definitely the dramatic complexity of today's market. We’re no longer operating in a straightforward reimbursement environment. The rise of high-deductible health plans, along with aggressive accumulator and maximiser programmes from payers and pharmacy benefit managers (PBMs), has created significant affordability challenges for patients. What was once a simple discount is now a critical strategic tool that directly influences both patient access and a brand’s overall financial health. As a result, manufacturers now demand more transparency, greater control over their spend, and better protection for their investment, transforming copay programmes into essential components of a commercialisation strategy.

Q. When manufacturers are designing a copay programme, what primary concerns or hesitations create that tension between ensuring patient affordability and maintaining financial control?

Most tension comes from the trade-off manufacturers feel they must make between patient access and cost containment. There's a legitimate fear that a generous affordability programme could lead to uncontrolled spending, financial leakage from waste or fraud, and a lack of visibility into how funds are actually being used. Furthermore, many legacy copay infrastructures were built on rigid, single-pathway systems that can’t adapt to today’s complexities. This creates a significant risk: when these static systems fail or are outmaneuvered by new payer tactics, patients are the ones who immediately lose access to their therapy.

Q. What specific gaps in the market led you to develop and launch a new, more advanced solution?

We identified a clear and growing gap between what manufacturers require and what most traditional copay solutions were designed to provide. Too many programmes were still functioning as simple transactional services, rather than as the strategic financial instruments they need to be. The market was missing a model that could shift from a static, one-size-fits-all approach to a dynamic, marketplace model. We saw the need to give manufacturers genuine control over their spending, provide robust protection against financial risks and, ultimately, ensure that patient access could be reliably maintained no matter how the market evolves.

Q. How are next-generation technologies like artificial intelligence (AI) being leveraged to move copay programmes from a reactive service to a more predictive and proactive model?

Advanced technology like AI is fundamental to this shift. AI allows us to move beyond simply reacting to claims as they come in and instead adopt a predictive and proactive stance. For instance, we can now use AI algorithms to analyse data in real time and identify patterns that indicate potential fraud, waste, or abuse before they can impact the programme on a larger scale. This AI-driven analysis is no longer a "nice-to-have" – it’s an essential capability for responsibly managing a modern copay programme and protecting its financial integrity.

Q. In a market with such varied insurance landscapes, how does a multi-adjudicator network give manufacturers the flexibility needed to ensure patients have consistent access to therapy?

The difference is transformative. A standalone affordability function operates in a silo, detached from the other critical elements that support a patient’s journey. This is the old way of working. An integrated model, however, connects the copay programme directly to data and analytics, patient engagement services, and programme integrity initiatives. This holistic approach allows insights from one area to inform actions in another. It means we can deliver far better outcomes by managing the patient experience seamlessly, from initial prescription to ongoing adherence, ensuring that affordability support works in concert with all other aspects of commercialisation.

Q. What fundamental shift in focus will define the most successful and sustainable copay programmes over the next five years?

The most significant shift will be from focusing on programme mechanics to focusing on the patient experience. Static rules and manual oversight are quickly becoming obsolete. In the coming years, manufacturers will demand programmes that provide real-time insights, include built-in financial safeguards, and can adapt instantly to changes in payer behaviour.

Ultimately, patients don’t care about the complexities of adjudication. They care about whether their medication is affordable and accessible. The programmes that succeed will be those that eliminate friction from the patient journey and provide that access in a financially sustainable way. The new industry standard must put the patient’s needs first while ensuring the long-term viability of the support manufacturers provide.

About the interviewee

Brian Laird is president of patient services at EVERSANA. He leads efforts to simplify care, improve access, and lower costs by delivering innovative, patient-centred therapy access solutions. With over 25 years of experience across pharmacy operations, clinical services, product development, and marketing, Laird brings a deep commitment to innovation and growth. Beginning his career as a pharmacist in ambulatory care, his patient-first approach continues to shape his strategic leadership. Laird has held executive roles at OptumRx and HealthDyne, where he drove specialty pharmacy expansion and tech-enabled patient service delivery. He holds a Pharmacy degree from the University of Mississippi School of Pharmacy and a Master’s in Pharmacy Outcomes and Policy from the University of Florida.