Pharmaceutical companies are taking big measures to boost sales of newer and brand-name drugs while addressing patient adherence concerns by stepping up “loyalty card” programs. As more insurers and employers switch to pharmacy-benefit plans with tiered formularies to help control runaway health costs, the proliferation of discounts on certain prescription medications is gaining traction, observers say, because they enable patients to reduce out-of-pocket costs.
“The big picture here is that manufacturers have many more options to connect with patients than simply having reps hand over samples to physicians,” says Rick Randell, president of National Patient Services, a unit of Triplefin (Cincinnati). “They can use coupons or vouchers as a means of delivering samples to the patient; they can use communications media ranging from interactive voice response (IVR) to text messaging to direct mail; they can use these programs to boost a product launch or to increase patient adherence.” Rendell adds that well-designed voucher programs can add as much as a full percentage point to market share on a product launch, or can add a month’s worth of days-on-therapy (a measure of patient adherence).
“More and more medication costs are being shifted to patients, increasing the patient’s out-of-pocket burden and affecting medication compliance and adherence,” observes Mark Calabrese, vice president and general manager, marketing solutions, Cegedim Dendrite (Bedminster, NJ), a firm specializing in pharma customer relationship management and data solutions. “This lack of medication adherence creates huge public health issues in terms of disease complications, leading to higher costs due to hospitalizations, disease progression and so forth.”
In their simplest form, patient-directed programs for Rx meds provide patients with a coupon, voucher, or loyalty card (distributed on paper or downloadable from a Web site) to redeem at the pharmacy, so they can start or continue drug therapy. Pharma companies often use copay discounts as part of a comprehensive solution to help increase patient adherence, a longstanding problem in medical care. In addition, drugmakers often rely on loyalty programs to help mitigate the costs of physician-prescribed therapies for patients who might otherwise not be able to access them.
Consumer advocates and physicians reportedly suggest loyalty programs can help patients save on drugs they already use, or when they try out a new therapy. “Physicians find these programs attractive as it enables them to prescribe what they feel are most effective for the patient, because an important cost consideration is alleviated,” notes Derek Rago, VP of marketing and strategy, McKesson Patient Relationship Solutions (Scottsdale, AZ), which specializes in designing, implementing and managing acquisition and adherence solutions. “Patient savings are typically delivered and implemented at the pharmacist’s counter at the point of dispensing and within the pharmacy adjudication system.” With each subsequent refill, up to the limit defined by the drug manufacturer, patients may receive additional copay subsidies.
McKesson’s LoyaltyScript program is positioned as a point-of-sale adherence platform that enables manufacturers to build strong relationships with patients to enhance clinical outcomes and maximize adherence to prescribed therapies. “LoyaltyScript lets manufacturers provide consumers with out-of-pocket savings on their medications at the pharmacy and can serve as a platform for delivering comprehensive adherence support, including refill reminders, motivational and health behavioral support, patient education, and more,” Rago explains. “Many times, the LoyaltyScript card also serves as a brand sponsored relationship marketing program, where patients can opt in to receive valuable clinical support and other incentives to remain adherent to their therapy.”
A byproduct of these programs is providing a means for doctors and patients to gain experience in new drugs and accelerate the education of both parties in the newest treatment alternatives. An added benefit is creating more connections between consumers and drug makers, experts say, as vendors have the ability to track patient activity in ordering/refilling prescriptions. “Ultimately, we improve the patient outcomes by making it a lot simpler and cheaper for drug companies to reach out to those patients who have been considered by their doctors to receive a particular manufacturer’s product,” says George Milevich, a spokesman for American Pharmaceutical Network (APN; Rochester, NY), a provider of prescription drug sampling services for pharma.
Value extends beyond discounts
Loyalty card programs are available from various sources, and there are different forms of distribution. For example, coupons for Rx meds – such as for chlolesterol-lowering drugs like Lipitor and asthma medications such as Symbicort – can be found in newspaper and magazine ads. “Often times, these cards are also available from a brand’s Web site, and thus a patient can download them from the Web, where together with a valid prescription, the patient can realize the savings at the pharmacy,” McKesson’s Rago points out.
Traditional copay card programs rely on the pharma sales force for distribution of the cards to health care practitioners. The cards are usually distributed to the patient by a physician at the time they are writing a prescription. “Redemptions occur at the pharmacy,” notes John Cunningham, vice president sales, TrialCard (Cary, NC), a provider of pharma marketing tools and services. “The claim is sequentially submitted to the primary insurer, then the copay card company.” Pharmacies are usually reimbursed for the claims twice monthly while drug makers pay for all production and administrative costs associated with loyalty card programs.
Loyalty programs vary in scope, each offering its own features and benefits. For example, McKesson’s LoyaltyScript program includes a patient identity card that, when presented at a pharmacy, connects the prescription to any type of copay reduction, sample incentive, or discount that a manufacturer (or other party) might provide. The program is used at more than 12,000 pharmacies (both inside and outside McKesson’s Health Mart franchise system) and can be connected with more than 40,000 other pharmacies through McKesson’s RelayHealth service. Manufacturers and pharmacies have the same goal in mind: to help consumers stay adherent to prescribed meds and ultimately achieve healthier patient outcomes, Rago says.
A voucher/coupon may come directly from the manufacturer, which patients take to physicians to encourage them to prescribe a particular drug. For instance, Cegedim Dendrite’s IntelliScript program offers three different “accelerators” to distribute cards to patients:
- “Mobile” is a communication channel allowing patients to react instantly to brand stimuli and receive copay offers directly to their cell phones/mobile devices;
- “Point of Fill” connects the brand’s copay offer to patients who do not have access to, or are not aware of the brand’s copay offer via their physician or the brand’s Web site; and
- “Print on Demand” empowers physicians and sales representatives to print the brand’s copay offers through a secure Web portal.
“The program is engineered to get more cards into more patient hands by helping overcome the physician-to-patient copay card distribution challenge,” Calabrese says, noting physicians may either be too busy or forget to distribute cards to patients, or run out of their supply.
APN facilitates an online system for distributing free drug samples and semi-subsidized drugs (discount cards). The system is said to be a fundamental improvement of traditional drug sampling programs because it provides manufacturers with greater flexibility to define and implement their marketing campaigns, as well as to gain insightful information about how well a particular promotion is doing. “This type of approach allows the healthcare provider to ‘create’ loyalty cards on demand and tailor them to the individual patients’ needs within the framework put by the drug manufacturer,” Milevich explains. “This way, the manufacturer is able to always have their loyalty program at the prescriber’s fingertips.”
The APN system offers a range of possibilities for pharma companies, prescribing providers and pharmacists. According to Milevich, the system offers transparency and the ability to keep in touch and respond instantaneously to practitioners’ trial drug needs. From the practitioner’s standpoint, it facilitates in-office voucher retrieval and generation, coupled with rich online scientific, medical and marketing detailing. “From the pharmacist’s standpoint, the system drives a lot of additional patient traffic and, in many cases of successful drug therapy acceptance, serves as a starting point in establishing long-lasting patient/pharmacist relationships,” Milevich says.
Some companies claim their loyalty card programs are distinguished by their innovation and focus on user friendliness. A case in point is TrialCard, which claims to be the first to issue a copay card and provide mail-in rebates processed in days instead of weeks. “We were also the first company to utilize an offer activation procedure towards garnering patient information, data used by our clients to target patients via DTC marketing efforts,” Cunningham declares. “We have spent the last nine years developing the technologies and pharmacy network necessary to provide manufacturers with seamless copay and sample programs.”
Vendors say the most effective loyalty card programs are those that offer a clear and significant value proposition to the physician and patient. To that end, the program needs to be multi-dimensional, providing meaningful education and patient resources in addition to copay assistance. “Patients need health related information such as health and wellness tips, counseling and support, therapy guidance, reminders, etc.,” says Ed Barret, managing director, Cue, a Group DCA company (Parsippany, NJ). “A loyalty program combined with a “cue card” and Group DCA’s patient education addresses many of a brand’s patient objectives.”
The company’s cue card enables marketers to provide DCA’s interactive patient education on the same card with the pharmacy incentive. The education portion of the card invites caregivers/patients into a user-friendly CRM dialog facilitated through the use of DCA’s proprietary software (brandnamed Diagram). “This means we can involve patients/consumers not only in core content that they should know about their condition and the therapy their physician has prescribed, but also in information that is most important to them,” Barret says. “They can opt to learn more about exercise tips, or about dietary changes that can also help them take charge of their health.”
The cue card synchronizes seamlessly with McKesson’s patient relationship programs, Barret says. “The process of developing the patient education and the set-up for the loyalty program are handled by a team of experienced professionals that leverage best practices to provide a customized client solution.”
Pharma companies can leverage the information gained from patients when redeeming the coupon/voucher enables to help track the effectiveness of their loyalty card programs. “Loyalty cards have an advantage in that activation and usage data are available more quickly,” observes Donna Wray, management advisor and practice leader, Internet and relationship marketing benchmarks, for TGaS Advisors (East Norriton, PA). “However, it takes a while to build a sufficient sample to get to an ROI. “ TGaS Advisors conducts confidential peer-set benchmarks in relationship marketing to help brand managers learn where their programs stand in relation to others in terms of such measures as cost per enrollment, changes in prescriptions, ROI, outcomes and optimization of the experience.
Evaluating the success of a loyalty card program is not an exact science, industry members say, as there are numerous variables to consider, each of which carries its own weight. “Success is typically measured in the direct impact of a program, meaning how many scripts can be directly attributed to the program and indirectly measured by how many scripts a physician is writing,” TrialCard’s Cunningham says. “One of the other goals is to provide sales reps access to their assigned physicians. Most recently, a major client indicated a 6:1 ROI based on the metrics mentioned above.”
The ROI analysis may be impacted by outside factors, such as the ever-changing nature of drug markets. And depending on how long it takes to complete such a report, the results may no longer be applicable. “Two alternatives every brand should do before a program launch and periodically after is a ‘back-of-the-napkin’ calculation to understand what values are necessary to show a positive ROI for the brand’s program,” TGaS Advisors’ Wray suggests, “and benchmark against other similar brands’ results to see how much room there may be for improvement in results.”
When looked at as a form of alternative sampling, a voucher program can represent significant savings over conventional physician sampling, says NPS’s Randell. Drug samples require a complex tracking system from the manufacturer to the rep, and then to the physician, and often are in the form of specially packaged starter kits. With a well-designed voucher program, the manufacturer can ensure that these costly kits go to patients they are intended for, and can be tracked more efficiently.
DCA’s Barret says the client’s business objective is always taken into consideration before loyalty card programs are developed and success criteria are defined accordingly. “Success criteria could be new patient starts, patient adherence, etc.,” he says. “We have been able to deliver superior results for our clients when cue cards are used to deliver much needed patient education and resources in conjunction with the prescription loyalty program.”
Most loyalty card programs define success metrics as the number of transactions/redemptions vs. number of physical cards produced. While this may represent a good initial success measurement, some observers suggest brands should delve deeper into the prescription-related behavior of patients and targeted physicians. “By looking at the patient’s length of therapy, it will help the brand understand whether their financial assistance program enabled patients to be more compliant (and follow their physician’s instructions), leading to overall better medication adherence,” Cegedim Dendrite’s Calabrese says.
To that end, the firm claims its IntelliScript solution is more than just a traditional copay card; it represents a strategic relationship marketing platform with important advantages. “It combines pre-program intelligence of the brand’s specific market, establishes a patient relationship (with an opt-in or enrollment component) through timed and triggered messaging options encouraging patient compliance and adherence,” Calabrese says, “and provides ongoing reporting and analytics, keeping the brand informed of program performance every step of the way.”
Some pharma companies may drill down even further by attempting to gauge patient and physician awareness of a new medication or formulation. In a study of LoyaltyScript patient adherence rates, McKesson reports it found patient conversion and persistence rates were higher among patients in the program and physician loyalty increased greatly. “Evaluating and understanding dynamics such as patient health behavior characteristics and motivations, product market dynamics and physician attitudes allow us to create a fully integrated and personalized adherence program,” Renfo says.
Feedback obtained from physicians and patients are also important for improving the quality of loyalty card programs, industry watchers concur. “We will always look at utilization patterns that provide us with feedback on physician acceptance of this fairly new and innovative approach to voucher distribution,” APN’s Milevich says.
For example, APN claims its electronic distribution method provides the drugmaker with the ability to monitor utilization of their drug sampling projects at every step. “In terms of cost, the complete elimination of the drug sample inventory component and having a 100% online fulfillment workflow allows to substantially reduce costs the drug manufacturer incurs and improve the ROI on their drug marketing efforts,” Milevich reports.
Coupled with significantly lower costs, the APN program is positioned as an attractive drug sampling solution for pharmaceutical companies of all sizes. “The online nature of the system has its own advantages,” Milevich says. “For instance, our software allows for an instant issuance of sample vouchers and discount cards to the physician, which can be done while the patient is in the office. Also, we can provide clinical information on the drug being marketed in all sorts of multi-media and printable formats, along with the voucher or discount card being issued.”
Discount or bribe?
Critics of loyalty cards contend these programs circumvent insurers’ cost-control measures to drive patients toward less expensive and just-as-effective alternatives, such as generic drugs. Depending on the insurance plan, copays for generics may be $10 or less and the highest, $50 or more, are reserved for brand-name medicines not on the preferred list. One look no further than discount cards recently offered online for certain drugs—such as Sepracor’s Lunesta sleep medication and Sanofi-Aventis’ AmbienCR sleep aid—which lower or may eliminate copays for the drugs under some insurance plans.
“Although many manufacturers have significant data showing the efficacy of their products, physicians are very sympathetic to patient financial concerns and are willing to prescribe less expensive options,” TrialCard’s Cunningham observes. “The critics of these programs are insurance companies; copay cards directly compete with their number one cost/formulary compliance mechanism.”
Industry studies reveal patients are becoming accustomed to the use of a loyalty card, both as a necessary part of belonging to a drug plan and as a desired part of retail shopping. These programs have shown to influence purchasing decisions as it relates to choice of pharmacy, some of whom offer their own copay assistance programs. Meanwhile, Internet and Web site traffic data suggests the number of patients researching for discounts on prescribed medication numbers in the millions, an indication healthcare consumers appreciate empowerment when presented with opportunities to realize significant savings on rising out-of-pocket Rx drug costs.
“On the positive side, people are more likely to stay on product and stay healthy,” TGaS Advisors’ Wray says. “Better health outcomes should always be the goal.” PC