Patient Affordability Programs

Go Beyond Traditional Copay to Deliver Customized Patient Support and Drive Therapy Adoption

The increasing prevalence of high-deductible health plans presents a dual imperative: ensuring patient access while protecting gross-to-net performance from financial leakage.

 While conventional affordability programs are ill-equipped to address these competing strategic pressures, EVERSANA has re-engineered our Intelligent Copay Solution as a dynamic financial framework, providing manufacturers with enhanced control over program spend.

The Intelligent Copay Solution equips manufacturers to navigate evolving industry challenges, including accumulator and maximizer programs, while ensuring consistent patient access to savings and improving gross-to-net performance.

Discover A New, Intelligent Copay Solution

Our platform is designed to proactively mitigate exposure to fraud, waste, and abuse while optimizing reimbursement pathways. This transforms the affordability program into a strategic financial lever, ensuring therapy continuity and delivering measurable improvements to your bottom line. 

Dynamic Marketplace

Through our partnership with Waltz, claims are routed through a network of 8 pharmacy benefit adjudicators, the most in the industry. The solution automatically selects the adjudicators offering the lowest reimbursement rate for each claim, generating direct savings for the manufacturer.  

Built-In Redundancy

By routing claims across a network of over 69,000 contracted pharmacies and multiple adjudication partners, EVERSANA eliminates single points of failure, ensuring 100% uptime and operational continuity, even during cyberattacks or system outages. This approach safeguards patient access and provides manufacturers with confidence that their programs will always be available when needed most. 

Advanced Fraud Mitigation

EVERSANA’s proactive strategy mitigates risk before claim adjudication using automated rules and machine learning to detect anomalous behavior. This approach has recouped over $400,000 for a single client by blocking 44 pharmacies and 21 government and discount BINs, preventing financial loss. 

Data Transparency

EVERSANA offers clients complete visibility into their data. Our upcoming “Chat with My Claims” capability, currently on the product roadmap, will allow clients to explore their claims data conversationally to uncover insights and support informed decisions. 

Tell us a bit about your business needs, and we’ll connect you with the right Patient Services expert.