The Right Card for The Right TrialPosted on 07/11/22
The right card for the right trial
Decentralized Clinical Trials have become more and more important. Easy access, patient retention and compliance are key factors of DCTs – and within the United States, patients having the right pharmacy card to pay or access the right medicine is an important factor for manufacturers to consider when determining how medications are paid for in a clinical trial.
Patient Insurance, Manufacturer Co-Pay Card Programs, Non-Profit Assistance Programs, Discount Card Programs
Patient insurance is highly variable in regards to coverage, coverage approvals (i.e. prior authorization etc.), and how medications are accessed. Patient out-of-pocket expenses can be variable and types of financial assistance vary based on if patients have government or commercially funded insurance.
Manufacturer funded co-pay cards can be utilized as a secondary payer, which means the patient’s primary insurance must pay some of the cost of the medication. Most co-pay cards have a maximum dollar value per year as well as maximum fills per year, including a remaining co-pay after the manufacturer co-pay card is applied. Manufacturer co-pay card programs are not available for patients who participate in government funded programs such as Medicaid, Medicare, or Tricare.
Charitable non-profit assistance programs such as Healthwell Foundation Organization and others provide beneficial financial co-pay assistance to patients but often funding is targeted and limited.
Discount card programs are usually used by patients when they have no insurance or underinsurance. Discount card programs only offer meaningful savings typically for generic medications and not branded drugs.
Sponsor organizations can potentially save money by placing the financial burden on patients, but there can be an impact on patient access and enrollment.
How the above types of pharmacy benefits impact patient access in clinical trials:
- If Sponsor organizations have determined not to pay for commercially approved standard of care medications in their clinical trial, this will pose a burden on patients in a non-uniform manner.
- Some patients may qualify for manufacturer co-pay programs, but others may not.
- Patients with government insurance do not qualify for manufacturer co-pay programs and have limited options regarding financial assistance.
- Patients will have varying financial burdens and differences in access to medications.
- Patients of different races and socioeconomic backgrounds may have different levels of financial coverage of medications vital to a clinical trial’s success. Not having a single uniform level of access for patients can have a negative impact on patients and the clinical trial, including a challenging site experience.
Clinical Trial Prescription Card (aka CTRx or CTRx Pharmacy Card)
Our CTRx pharmacy benefit cards that are Sponsor funded typically act to cover the entire cost of prescribed medications without using the patients’ insurance. This is the case when patients enroll in a clinical trial and the Sponsor will cover the cost of the standard of care medications. When using a CTRx card, there is no insurance utilized. So, no verifying benefits or prior authorization or step therapy requirements, which would faster track the patient to therapy. This also means that instead of bulk supply at the site, the supply is initiated by the prescriber writing a prescription once a patient is approved for the clinical trial and a specialty or outpatient pharmacy dispensing the medication upon receipt of a prescription. The CTRx pharmacy card is utilized by the pharmacy for payment. There are over 70,000 pharmacies that can accept the CTRx pharmacy card and Myonex designates which pharmacies can dispense the medications based on the trial requirements.
How does the CTRx program benefit Sponsors, Sites, Patients:
- Sponsors can provide access to clinical trial patients in a uniform manner. The level of benefit is consistent, and all patients have the same level of access.
- Sites/Providers/Patients will have a positive experience vs. pursuing coverage via insurance as there are no traditional hurdles such as prior authorizations and financial assistance.
- Clinical trial site research departments do not have to manually procure expensive medications and bill Sponsors, decreasing the financial burden on sites
- Sponsors do not have to bulk purchase product up front. There is no overage in this method and at the same time, Sponsors are providing a streamlined method of access to medications patients need in a clinical trial.
- Medications that can be accessed through our CTRx program can be specialty and non-specialty medications.
- The program is compliant with applicable requirements of the Sponsor with total control of what is covered with the CTRx Pharmacy Card. There is timely reporting visibility at the subject number level, which is not available to Sponsors if they elect to use other coverage programs in their trial
- Contact us to discuss how our CTRx North America solution and the future CTRx Europe solution with a European Central Pharmacy Network can support your trial: [email protected]
Project Manager, Patient Solutions