Several recent developments have caused many people in our industry to think differently about affordability and access.
In July, GoodRx and Boehringer Ingelheim announced a patient affordability initiative to provide citrate-free Adalimumab-adbm, Boehringer’s biosimilar to Humira® (adalimumab), at a low cash price—the first biosimilar with this offer on GoodRx. In August, CMS announced prices of the first ten medications impacted by the Inflation Reduction Act that enables Medicare to “negotiate directly with drug companies to improve access to some of the costliest single-source brand-name Medicare Part B and Part D drugs.” And in October, GoodRx announced the availability of new affordability programs for menopause hormone therapies (MHT) by Pfizer, particularly for women facing limited coverage and high out-of-pocket costs.
Different approaches to a common problem
These examples are responses to increasing financial demands shifting to U.S. consumers for their healthcare, including prescription medications. These shifts are, in part, the result of increases in utilization management and patient cost-sharing for prescription drugs, with more consumers opting to pay cash. In fact, due to insurance plan designs, patients and pharmaceutical manufacturers have become larger payers in the total cost of healthcare—patients through high deductibles and pharma through copay assistance programs and PBM rebates.
Pharma’s access and affordability evolution: One drug to many
Historically, pharma brand teams have been rewarded for building patient affordability systems optimized for one product. At GoodRx, we’re starting to see pharma clients expand their perspectives on access and affordability from one product to multiple brands or the entire enterprise; go beyond retail to specialty; and use our platform to enable copay, cash, and patient services enrollment. This delivers improved capabilities and insights well beyond what they would get from a single program for an individual brand.
Pharma’s gross-to-net problem and the patient-as-payer
Figure 1 lists three reasons why patients are increasingly payers for prescription medications. Simultaneously, pharmaceutical manufacturers are paying ever higher rebates. Factoring in copay assistance with rebates, many brands are under water on a net basis, particularly in the first quarter of each year. Even with “good” market access coverage, most brands still have gaps or utilization management hurdles that patients must overcome.
GoodRx can provide an alternative access and affordability strategy while giving manufacturers direct line-of-sight to unit economics at a claim level. We have more than 50 brands leveraging our point-of-sale cash buydown solution that directly applies a manufacturer-sponsored discount outside of any PBM network.
GoodRx cash buydowns: Part of the solution and a win for stakeholders
Cash-paying patients have steadily become a bigger part of most retail and specialty-lite brands’ eligible customer base, so it’s important for pharma to have a cash-pay strategy. At the retail pharmacy level, GoodRx helps pharmacies not lose money on brand drug prescriptions they fill using a pharma-sponsored GoodRx coupon.
We also give HCPs confidence to write prescriptions for branded drugs by showing them that an affordable cash price is available, thereby mitigating utilization management barriers. Most importantly, we further GoodRx’s mission of helping Americans get the healthcare they need at a price they can afford.
GoodRx’s integrated model: Evolving relationships, improving results
In addition to cash pay buydown programs, pharmaceutical companies use GoodRx to deliver copay assistance programs to eligible patients and drive enrollment at scale for their patient support services. Our goal at GoodRx is to reduce friction and create a more seamless experience for patients to get the best affordability and access solutions available to them.
We’re also collaborating with our pharma partners to develop and implement next-generation solutions. Pharma’s shift to considering an enterprise approach for access and affordability is enabled by GoodRx’s sheer scale (one in four Americans use the platform), common interface across brands, and integrated model. Our model represents a step-change in how pharma interacts with patients, offering more personalized, value-driven solutions that keep pace with their changing needs.
Looking ahead, thinking bigger
One manufacturer that has evolved over several years with GoodRx is Boehringer Ingelheim, moving from our first brand copay integration and cash solutions to portfolio-level programs, from retail to more complex specialty brands, and recently offering the first cash buydown for a biosimilar on GoodRx. According to Boehringer’s Christine Marsh, SVP, Value & Access, “These programs highlight the importance of collaborating with partners—at scale—to keep pace with consumers’ changing requirements for affordability and access programs that can help solve their problems at the pharmacy counter and ultimately lead to better health outcomes. We cannot address new problems with previous ways of thinking.”
In this evolving environment, GoodRx’s integrated platform model offers pharma companies a more seamless way to deliver value to consumers and HCPs at scale while navigating the complexities of today’s healthcare system.
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