Case study: optimizing co-pay program benefit design

Kelly Renfro

McKesson Patient Relationship Solutions

Much has been written lately about the complexity of medication adherence and the variety of barriers that impact whether or not someone takes their medicine. Barriers can range from financial concerns to product and condition-specific beliefs or behavioral perceptions depending on where patients are in the adherence process. Designing an effective adherence program requires that we understand this process as well as which barriers are keeping them from taking the next step — this is essential for providing the right message at the right time using consumer-friendly language.

In cases where financial constraints are one of the primary barriers, adherence can often be addressed through a co-pay program. Studies have demonstrated a strong link between patients’ out-of-pocket costs and the rates of abandonment. For example, results from the study, “Epidemiology of Prescriptions Abandoned at the Pharmacy,” published recently in the Annals of Internal Medicine, showed that 1.4% of prescriptions are left unfilled with $10 co-pays. The rate of abandonment tripled to 4.5% unfilled for those with co-pays of $50 or more.

While this study reinforces the value of co-pay programs, brand managers should not settle for off-the-shelf, one-size-fits-all co-pay programs. Leveraging best practices from delivering point-of-sales consumer programs for more than 15 years, we have learned that impactful and motivating co-pay programs require the same comprehensive strategic planning process as any program designed to generate health behavior change. The following case study outlines the results of methodically analyzing market influences when designing the right co-pay program as well as the importance of ongoing campaign management.

“Designing an effective adherence program requires that we understand this process as well as which barriers are keeping them from taking the next step…”


A chronic, symptomatic brand experienced sluggish prescription growth, and market research determined a significant number of patients were abandoning the prescription at the point of sale. To drive prescription volume and minimize abandonment, the brand team created a program that offered eligible patients up to $50 off their co-pay.

Initially, the program enjoyed tremendous uptake and adoption with more than 500,000 patients participating in the program within the first 18 months. The brand team attributed much of the early success to the generous co-pay benefit. However, ongoing analysis and program management uncovered opportunities to further optimize program performance. Analysis demonstrated that even with the co-pay benefit, more than 35% of patients in the program still had an out-of-pocket cost in excess of $60. As a result, the rate of abandonment within this group was more than 65%.


Utilizing market-abandonment data to benchmark initial results against our proprietary database of industry-wide program data, the program was shifted to a “Pay No More Than” scenario with a “benefit cap” to control program spending. Together, the new benefit design improved program performance, successfully addressing co-pays in excess of $60, controlling program cost, and delivering a stronger overall marketing message to the patient and the doctor.


The brand achieved its objectives of reducing abandonment and continued to maximize patient utilization as measured by increasing pharmacy claims. Specifically, the new benefit design resulted in a growth in pharmacy claims of nearly 50% (Illustration 1) and more importantly, enabled a significant reduction in the number of participating patients experiencing high out-of-pocket costs.

Average patient abandonment rate decreased 45% for participants compared to patients that did not participate in the brand program (Illustration 2). Additionally, the “Pay No More Than” benefit design reduced abandonment for patients with an out-of-pocket cost in excess of $60 by more than 25 percentage points.

“…out-of-pocket costs and co-pay programs play a significant role in patient adherence.”

Optimizing co-pay program benefit design

These results clearly demonstrate that out-of-pocket costs and co-pay programs play a significant role in patient adherence. Designing the most effective co-pay program to improve adherence requires ongoing analysis and optimization.

An intelligent benefit design that examines industry dynamics such as prescription abandonment, generic erosion, competitive drug launches and average out-of-pocket costs as well as consideration of brand nuances can help to mitigate the uncertainties. Ultimately, keeping a strategic eye on program performance plays a crucial role in ensuring brand objectives are met and patient persistence and compliance goals are achieved.

About the author:

Kelly Renfro is the Marketing Manager for McKesson Patient Relationship Solutions, an industry leader in providing commercialization and adherence services for pharmaceutical manufacturers. She has over 20 years experience in pharmaceutical marketing and data analytics and is currently responsible for measuring the effectiveness of the company’s alternative sampling program, TrialScript®, and their market-leading patient adherence program, LoyaltyScript®.

Prior to joining McKesson, Kelly was a Product Director at NDCHealth (Wolters Kluwer Health) where she was responsible for developing new prescription informatic products for pharmaceutical manufacturers that optimized their sales and marketing efforts and allowed them to more effectively pursue market opportunities for their products.

How much of an impact do you think out-of-pocket costs have on adherence?