Optimizing Copay Cards

Copay card programs are the most common patient support tool and are leveraged by every pharma/biotech brand to decrease the likelihood patients face “sticker shock.” But most copay card programs aren’t optimized to maximize patient access because a copay card is not just a number—it’s a policy patients must understand, a workflow pharmacies must be able to execute, and an awareness challenge across everyone involved in the start and refill journey.

If you’re seeing wasted spend, frustration at the counter, or no improvement in persistence, one of these three areas is usually the culprit.

1) Policy: What it provides (and what it doesn't)

Common signs you have a policy problem:

• Patients think the card will “cover everything,” then abandon when they hit a cap or exclusion
• The benefit is strong for low-need patients but still inadequate for high-friction moments (e.g., first fill sticker shock)
• Terms are hard to explain quickly (duration, per-fill vs annual cap, renewal rules)
• You’re constantly creating one-off exceptions (“Can we override this just this once?”)

Why it happens

Program requirements are often designed around budget and risk avoidance, not the moments that actually drive abandonment. If the terms & conditions don’t match the real-world barriers that patients hit, you get two bad outcomes at once:

• Patients still drop
• Support teams get buried in questions and exceptions

Hot tips

• Be explicit about what it does not cover. Plain language wins: caps, duration, eligibility boundaries, what happens at renewal, government-exclusion, etc.
• Align the benefit to the “make-or-break” moment. For many brands, that’s the first fill; for others, it’s refills after benefit resets

2) Workflow: How it works (at the pharmacy counter, every time)

Even a perfect policy fails if execution is unreliable. Workflow is where copay programs either deliver a smooth start—or create the “it didn’t work” moment that triggers abandonment.

Common signs you have a workflow problem‍

• High claim rejection rates, reversals, or delayed activation
• Pharmacies call your hub frequently - or stop trying because it's too painful

‍Why it happens

Copay workflows are dependent on business rules that reflect patient activation, payer edits, accurate coding, etc. The more parties involved, the more that can go wrong.

Hot tips

• Analyze the top reject reasons. If you don’t have a weekly view of activation success rate + reject reason codes +resolution time, you’re flying blind.
• Create a pharmacy one-pager. Include processing info, troubleshooting steps, escalation contact.
• Build suppression logic into patient support. If the claim fails, route to help; don’t keep sending generic reminders.

3) Awareness: Who should know (and how they should find out)

Many copay programs underperform because the right people don’t know they exist—or they find out at the wrong time.

Common signs you have an awareness problem

• High abandonment rate for patients who would have qualified for the copay card but did not enroll
• Hub call enter receives "basic questions" from patients that should've been answered earlier
• Enrollment varies wildly by geography, site, or pharmacy

Why it happens

Awareness is often treated like “marketing,” but for copay it’s really timing + routing. If a patient learns about the card after the moment of sticker shock, you’ve already lost.

Hot tips to optimize awareness

• Make discovery moment-based, not campaign-based. The best time is when the patient hits the barrier: at benefit verification, at eRx intake, at the counter, at refill due.
• Equip those who can "catch" the problem. " Provider offices, SP intake teams, hub agents, pharmacists—give them a consistent script and a one-click path.
• More than just brand.com. If you rely on patients to "go find" your copay card through search or a generic brand website, you're likely leaving new starts on the table.

‍The Takeaway

Most copay issues are fixable without a full redesign, and to be honest, you should be tracking metrics on a quarterly basis to make sure you can quickly identify the failure mode:

• Policy is unclear or misaligned to real friction
• Workflow breaks at the counter or in processing
• Awareness doesn't reach the right people at the right moment

‍Next Steps

Want to pressure-test your program? We can walk through your policy, workflow, and awareness strategies to identify where upgrades can be made. Speak with one of our experts.

Need help designing a copay card program? We can work with you to design it from scratch. And it won’t just be polished slides, we’ll give you the implementation plans too. Speak with one of our experts.