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What is a co-pay?

What is a co-pay?

A co-payment, or co-pay, refers to a common form of cost-sharing leveraged by health insurance plans. The fee is a fixed payment that patients are required to pay for a healthcare service. While a patient’s health plan might cover that healthcare service in full, they typically also require that patient to pay a co-pay.

What does a pharma company need to know about co-pays?

Pharma companies need to know about health insurance companies’ co-pay information to help inform and influence their commercial strategies. Here’s how:

  1. Co-pay information can help pharma companies understand how and why patients may not be accessing their medications. High co-pays are often a barrier to adherence, which, ultimately, affects a drug’s market share.
  2. Co-pay information is often a deciding factor on which drugs are placed on formulary and how.
  3. Knowledge of co-pays helps pharma competitors better understand their competitors and assess the competitive landscape overall.
  4. Pharma companies may choose to develop co-pay assistance programs to help patients afford their medications if the co-pays are high.
  5. Assessing trends in co-pay amounts—like how they change over time or regional variations—can help pharma companies adjust their pricing and access strategies.
  6. Co-pay data is crucial for helping manufacturers develop reimbursement strategies for healthcare providers, and provide insight into the best approach for encouraging HCP uptake.
  7. Manufacturers may use co-pay information to inform their regulatory submissions and the cost-sharing environment in different markets when seeking drug approval.
  8. Pharma also uses co-pay data to inform their pricing strategies, taking a patients’ out-of-pocket costs into account.

How does a pharma company gather co-pay information?

Data on co-pays can be collected from various sources, including healthcare technology vendors, market research companies, healthcare providers and insurance companies. When seeking to understand co-pay dynamics to inform your market access strategy, choosing a trusted data vendor is key.


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