Last Saturday, I received the Johnson & Johnson COVID vaccine. My husband received his first Moderna shot a day earlier. Tears welled up in my eyes when we pulled out of the vaccine center parking lot in Oakland. I popped open an airline app on my phone while my husband drove. I counted out 28 days until I felt I could safely fly to Boston. Sixteen months have passed since I last saw my (now) 87-year old mother in person. My husband and I debated whether our young son could come with me to visit Grammy. He was more supportive of the idea than I was, but neither of us like our options. We decided: No, not yet; maybe in the Fall. We all look forward to some magical time later this year where (well-founded) fear won’t compete with the ache to hug family.
My immediate circle has been lucky. We did not get COVID. And that’s all it was: luck. Yes, you can reduce your exposure risks by sheltering in place, handwashing, and wearing a mask. These tactics all measurably reduce disease spread. But I know nurses, and utility workers, and nursing home residents for whom risk reduction could never be 100%. They contracted the virus through no fault of their own. Just crummy luck.
Some people (were it not for shelter-in-place orders) should be patients today. Not with COVID, but with some other malady lurking, still undiagnosed:
- She would have stopped telling herself that it was stress or something she ate.
- The kindergarten teacher would mention their daughter’s frequent trips to the bathroom.
- She would drop the groceries off at her folks’ and notice her Dad had started having trouble walking.
- His buddies would have seen that he’s still “not himself” after the divorce and asked him about maybe talking to his doctor or someone.
COVID has taken so much from so many. How much it will take (directly or indirectly) is unknown. We know that women were significantly more likely to skip or delay preventive care than men. Interestingly, women with higher household incomes or commercial insurance were much more likely to delay care. One explanation may be that if you could afford to shelter-in-place, you may have shared the belief that staying at home offered more significant health benefits than leaving the house for preventive care. Another is that remote learning, more often than not, was managed by Mom.
Interestingly, the number of uninsured patients did not spike during COVID as many had feared. Early analysis suggests that enrollment in Medicaid and Marketplaces may have balanced the loss in employer-sponsored coverage.
I can’t speak to the clinical impact or population health trends that COVID will drive. I don’t know about you, but my crystal ball has looked more like a snow globe since February 2020. That won’t stop me from making a few predictions regarding patient needs and considerations for Pharma and Biotech manufacturers in the COVID-vaccinated era.
If you offer copay support to commercially insured patients, you may see your program spend stay the same (or even increase) even if patient volume declines:
- There will be fewer commercially insured patients, but they will be more likely to use copay support (= higher copay utilization).
- The # of copay patients maxing out your program’s benefit cap and your average assistance benefit per transaction will be higher.
Why?
Deductibles: Deductible Relief Day ain’t gonna be in May this year.
In 2019, the day by which most Americans with employer-sponsored health coverage would have met their plan’s deductible was May 19th. I tried a quick google search for Deductible Relief Day 2020, and 2021, respectively, and I got zip. Not surprising at all, given that:
- If folks have suffered job loss due to COVID, they may have lost their employer-sponsored coverage. If and when they find new employment (and employer-sponsored health insurance), they will be starting at zero dollars paid towards a deductible.
- If workers experienced no disruptions in their employment (or health coverage), their healthcare consumerism will probably still be low in 2021. Maybe in an average year, they hit their deductible in May. October is more likely in 2021, with the notable exception being patients with high medical needs and already established therapy (example: Type 1 diabetes).
If your manufacturer offers a free medication program (commonly referred to as a Patient Assistance Program or PAP), don’t be surprised if applications from patients new to treatment are down while applications from established patients are up.
- COVID aside, low-income patients who have lost their health insurance and are waiting on Medicaid eligibility will delay going to the doctor. At this point, manufacturers may ask, “Well, what if we help them with getting their doctor visits?” And this would be where I play the heavy, and say, “No,” if the patient has not been prescribed the manufacturer’s medication. It is absolutely worth reaching out to Patient Advocacy groups to explore how manufacturers can help patients. In that scenario, however, the manufacturer should not have the expectation that assistance would be available only to patients on their branded products.
- Patients continuing on therapy may apply for your PAP as a stop-gap while they’re between health plans. If you’re thinking about expanding your PAP program eligibility to accommodate these patients check in with your cross-functional partners:
- Confirm that your PAP program rules and accounting practices don’t inadvertently influence best price or Medicaid rebate calculations for your brand.
- If you have patients in a gap between commercial coverage and a government sponsored-plan, ask your Legal team if patients can transition from PAP to purchased/insured product once their government coverage becomes active. In some cases, patients with public insurance and receiving PAP medications need to stay on PAP through the end of the calendar year, not when their new health coverage kicks in.
I’m sure that we’ll be sharing additional thoughts and observations on Patient Support in Post-Vaccine 2021. Please don’t hesitate to email me if your team needs help navigating the road ahead.
And here’s to flying the friendly skies with our families soon.
