AH085 - Addressing Barriers to Drug Access & Affordability, with Valeris' Andy Glade

Transcript

Lightly edited for clarity.‍

[00:23] Justin Venneri: Hello and thank you for listening to another episode of Astonishing Healthcare. This is Justin Venneri, your host and Senior Director of Communications at Judi Health, and we're excited to welcome one of our clients to the show today. This is a unique partnership on the benefit administration or quote unquote tech side of the business. So, Judy, primarily our enterprise health platform. And we have Andy Glade, Senior Director of Trade Operations at Valeris, in the studio with me to chat.  

Andy, thank you for joining me today.

[00:49] Andy Glade: Hey Justin, thanks for having me.

[00:51] Justin Venneri: So, Andy, tell us a bit about your background and your role at Valeris, and also give us the elevator pitch.

[00:57] Andy Glade: Yeah, so my background is pretty much deeply rooted in healthcare. I spent over two decades at one of our country's largest pharmacy benefit managers, and there I focused a lot on helping patients navigate things like prescription coverage and cost and adherence. Through that, I really got to see firsthand how complicated the system can be and more importantly, where it doesn't always work well for the people it's supposed to help.  

Fast forward to today. I've been with Valeris for five and a half years. We're a healthcare company with two main campuses, one in Jeffersonville, Indiana and where I am in Morrisville, North Carolina. And the mission is pretty straightforward: we make it easier for patients to get the medications they need. We work with hundreds of life science companies to help people start and stay on their treatment, especially when cost or complexity might get in the way.  

And what makes Valeris unique is we bring together smart technology, real human support, and a deep understanding of the healthcare landscape to help remove those barriers. We're not just checking the boxes, we're helping improve outcomes and, honestly, making healthcare feel a little bit more human.

[02:04] Justin Venneri: Okay, patient assistance. So your clients are mostly the pharma companies, life sciences companies, like you mentioned. And patient assistance comes in different forms. I would love to hear your overview of pharmaceutical drug coupons, vouchers and co pay cards. Are they all the same thing? Are they all under the same patient assistance category? I know I do that often, I ask lots of questions in one, so forgive me, but love to hear an overview.

[02:29] Andy Glade: Oh, you're good. It's a really good question. Honestly, it's a really common point of confusion. People do tend to lump all those programs together under the term “patient assistance.” But they're actually pretty different in how they work and who they help.  

So there's really three main types of programs. There's copay cards and vouchers, as you mentioned. There's also patient assistance programs known as PAP.  

So let's start with the copay cards. These are usually for patients that have commercial insurance. It's a manufacturer sponsored card that helps lower out of pocket costs like copays and coinsurance. They can't be used with government programs, like Medicare and Medicaid, but they're for privately insured patients that face high copays. They can make a big difference in keeping people on therapy.  

Then there's the vouchers. They're a little different. They typically offer a free or heavily discounted supply of medication, like maybe a 30-day starter dose. They're often used when a drug is first launching or when a provider wants to get a patient started quickly, maybe even before their insurance kicks in. So the idea here is to remove that initial cost barrier, encourage patients to try the therapy.  

And finally we have those patient assistance programs. Those are more of a charitable model. They're designed for people who are uninsured or underinsured or facing a serious financial hardship. If someone qualifies, they often can get their medication for free. So this is really about helping the most vulnerable patients access the treatment they need when there are no other coverage options. They're all different tools in the toolbox, Justin, but serve different purposes depending on the patient's situation.

[04:01] Justin Venneri: Got it. What kinds of drugs need copay cards? Is it all sorts, mostly branded?

[04:06] Andy Glade: Yeah, so copay cards typically are used for brand prescription drugs, especially the ones that may come with a higher price tag for patients. A lot of times we see them for drugs that are on the higher tiers of insurance, formulary, where out of pocket costs can be significant. Even if the drug is covered, patients may still be looking at high copays or coinsurance. And that's where that copay card can step in to help.  

They're also super common in competitive drug categories like diabetes, or asthma, or psoriasis, where multiple branded drugs are fighting for market share. A copay card can make one option more financially attractive, which can drive adherence and brand loyalty. And of course, they're also used with specialty, which can cost thousands of dollars a month. In those cases, a copay card can reduce the patient's cost dramatically, sometimes down to zero, which can be the difference between someone staying on treatment or not.  

So bottom line, copay cards are mostly used when cost is a real barrier, and especially when a drug manufacturer wants to help patients access their products and stay on them.

[05:06] Justin Venneri: So my next question was going to be, why are they beneficial for patients of these drugs? But it does seem pretty obvious from your answer that it really hits at that financial barrier and just making it easier or taking away one barrier so that it's easier for the patient to access the drug when they need it.

[05:21] Andy Glade: Yeah, the financial barrier is certainly a major factor, but there are other benefits as well. These medications tend to treat serious, chronic, maybe even life-threatening conditions. So getting access to access to them can have a huge impact on someone's health. We're talking about better control of diseases like autoimmune disorders, slowing the progressions of things like cancer or MS, fewer ER visits, and just an overall better quality of life.  

And also they give patients access some of the most advanced treatments out there. We're seeing targeted therapy, biologics, even gene therapy in some cases. These are cutting edge innovations. Without support like copay cards offer, a lot of people just simply couldn't afford them.

Related Content

• 12 New Judi® Features Innovating Pharmacy Benefit Administration
• Replay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better Outcomes
• AH081 - Promoting Competition & Innovation: The Push for PBM Reform, with Rep. Jake Auchincloss
• Health Benefits 101: The Importance of a Transparent PBM Model
• Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive Impact

[06:01] Justin Venneri: So what's the general patient experience like with these cards and the associated programs?

[06:06] Andy Glade: Yeah, the patient experience pretty powerful. And there's a few stages.  

First of all, you have your immediate financial relief. Imagine hearing the price of that medication is $300 or $400 or $500, and it's just like a gut punch, like, I can't afford that. Then the pharmacist says, well, wait, there's a program that can bring your costs way down, maybe even to zero. And it feels like a huge weight is lifted, you know, like you're empowered to start your treatment right away.  

Then you have the access. These programs are designed to make things as smooth as possible. Sometimes the copay card is already active, or the clinic, you know, your provider does all the heavy lifting for you, so there's not a lot of paperwork to fill out. So it makes access pretty straightforward.  

Then there's consistent coverage over time. These copay cards aren't just one-off deals. It could cover a full year or more. And sometimes you get automatic reminders for renewals. And the pharmacy is really good at processing these benefits without any billing headaches. That consistency helps the patient build a routine and gives them the confidence to stay on their meds without surprising financial costs coming up.

[07:05] Justin Venneri: That sounds like it's great for chronic conditions.

[07:09] Andy Glade: Absolutely. These folks have so much to worry about, you know, and not being able to afford their medication once. If you take that off the table, it's a huge plus. Patients, you know, we hear patients say, for the first time, I felt like someone actually cares if I can afford my medication. And they feel the real health improvements, you know, when the drug works and it's affordable from day one, and patients start on it and stick with it, their symptoms approve, their side effects are manageable, and life just, it's more normal again, it's a positive outcome for all those reasons.

[07:37] Justin Venneri: Is there like a max benefit or how much does a patient typically end up paying? I know you said sometimes it's zero, very low, out of pocket.

[07:45] Andy Glade: Yeah, sometimes there's a max benefit. And the answer to your question is it depends. We work really closely with the clients to design programs that fit their specific needs and goals. Some programs might have a cap, like a maximum dollar amount or a limit on the number of fills you can get. Others are more flexible and don't have a hard max at all.  

Bottom line, though, it's about finding the right balance to make sure patients get the support they need and align with that manufacturer's objectives and the patient's perspective. Those copay cards bring the cost down to, like you said, maybe even zero, which is a huge deciding factor in whether they can stay on their medication.

[08:18] Justin Venneri: And you or your team use Judi®, our enterprise health platform, pretty extensively, or so I've heard. And I'm definitely not trying to get too salesy here, but can you tell me a bit about that experience and why it fits your business model? What can you guys do with Judi that you can't do with other claims processors?

[08:36] Andy Glade: Justin, you have to promise not to tell my wife, but I'm in love with Judi. Seriously, it's been such a game changer for our team. If I had to joke about it, I'd say using Judi compared to other platforms, it's like comparing the space shuttle to a tricycle. The speed, the flexibility, it's just on a whole other level, when we can honestly build a simple program in 15 minutes. That's just absolutely wild compared to other processors where you have to submit a request and then wait around for their team to do it.  

Judi lets us be in control, which makes us way more nimble and faster, especially when juggling multiple clients and tight deadlines. But what's really cool is that state of the art beta testing scenarios that Judi offers. We get to see new features early, test them out, and provide feedback before anything goes live. It's a really smart way to make sure everything runs smoothly, and it fits our needs just perfectly.  

And there's reporting, which is fantastic. It gives us real time, detailed insights that help us track how programs are performing, catch any issues really quickly, and allows us to share meaningful updates with clients. You know, if a client escalates something urgently, which as we know happens, we can even push changes live the same day. We don't often do that but having that ability is a lifesaver when timelines are tight.

[09:51] Justin Venneri: That's great to hear that. Like it actually does some of the stuff we say it does. So that's awesome.

[09:56] Andy Glade: It does. And I just wanted to not to forget about our partnership with Capital Rx is fantastic. Super responsive, always improving the UI based on our feedback and we're never caught off guard with updates. Training new users is so easy. The fields have built in explanation. So you know, our team is growing constantly and getting new team members up to speed without a ton of handholding is key. The UI platform is some of the best we've ever worked with. It fits our business model perfectly with speed and control and the ability to be super responsive to our clients. It makes our life easier. It's definitely the space shuttle in a world full of tricycles.

[10:34] Justin Venneri: And I'm curious about on top of that -- and thank you for that, it's nice to hear -- I'm curious about your view of, there's tons of press, health policy issues flying around lately, and lots of changes we've seen recently or pushes for change. A lot of it is around greater drug price transparency and lower prices for patients. I'm curious how you view these changes and if they potentially impact your business or how it does impact your business.

[10:56] Andy Glade: That's absolutely really important. We welcome the push for greater drug transparency and better affordability. The whole health care system is evolving and that's really a good thing. But through all the changes, our mission doesn't change helping patients start and stay on the medication they need without cost being a barrier.  

You know, those copay cards and vouchers play a vital role. They provide immediate real savings to patients and that's something no policy can guarantee right now. Those regulatory shifts you were talking about around price transparency and copay accumulator programs are designed to improve things, but for many patients it's still a really complex system. That's where these affordability programs fill a critical gap. They help patients get quicker access to their meds, reduce the chances of abandoning prescriptions at the pharmacy, and ultimately support better adherence and health outcomes. Especially true for brand name and specialty medications where high cost can be the deciding factor between staying on therapy or walking away.

[11:50] Justin Venneri: It's interesting that you say that because Michael Kleinrock highlighted that in IQVIA's annual report - pretty consistent still, 27% of prescriptions are abandoned at the counter; I guess it would be worse if not for programs like this and their growth.

[12:03] Andy Glade: Over time because cost is a major factor for that walking away. You know, behind every copay card or vouchers, a patient who finally got access to the critical treatment didn't have to choose between their medicine and groceries, felt like the system was working for them. Those are the moments that really matter and we're really proud to play a role in them.

[12:20] Justin Venneri: Okay, I just have two more questions for you, Andy, a bit of a curveball. First, what's the most interesting question you get about these programs or your business and how do you answer it?

[12:29] Andy Glade: One of the most interesting questions I get asked is what's the biggest and most impactful benefit of copay and voucher programs? And honestly, it's a really good question because it gets to the heart of what we do and why we do it. At the end of the day, these programs have helped millions of patients across the country not just start their meds but stay on them even when life throws curveballs or finances are tight.  

So like the critical bridge between having a prescription and in hand and actually filling it. You know that moment when a patient hears the cost and it feels overwhelming copay cards and vouchers remove that barrier. Right. When patients are the most vulnerable.

[13:03] Justin Venneri: All right, last question. Andy, thanks for taking the time today. Thanks for explaining what you guys do, what these programs mean for patients.  

What is the most astonishing thing you've seen or heard? And I know you've had a long career so got to keep our compliance hat on, and I know you've seen a lot. So give us a good observation or something astonishing you've seen that's safe to share, of course, and send us off with a good story.

[13:23] Andy Glade: Yeah. So there's one story that really sticks with me, and it's a good example of real-life impact these programs can have. There was a woman in her mid-30s who had just received a serious life altering diagnosis. And there was a lot of fear and a lot of uncertainty. And her doctor prescribed a branded injectable therapy, a well-established treatment, to slow the progression of her disease. And they sent the prescription to a specialty pharmacy, then got processed through her regular commercial insurance.  

But here's where everything went off track. She found out her out of pocket for the first fill was over $2,000 and she froze. She didn't call the pharmacy back. She never picked up the medication and she didn't tell her doctor because she was embarrassed, not because she didn't believe in the treatment. She just couldn't afford it. Three days later, a care coordinator from the patient support hub reached out. They explained she qualified for this co pay card program which would bring her out of pocket costs from that over 2000 down to zero. And best of all, they handled everything directly with the pharmacy. No paperwork, no issues, no problems. This lady said I was too embarrassed to tell anyone I couldn't afford the medication. Honestly thought this was how it was going to be for me. She had no idea help like this even existed. So the prescription got processed, she started the therapy, followed up with her doctor. Everything's going really well.  

So you know what? Those are the kind of stories that remind me why these programs matter so much. Not just financial relief, but the emotional and practical support that really can change lives.

[14:44] Justin Venneri: That's a good one. Love a feel-good story at the end of an episode. So Andy, thank you so much for taking the time today. Hopefully we can have you back on in the future and hear about updates to these programs and updates to the business and partnership.

[14:54] Andy Glade: Yes sir, thank you for having me. It was enjoyable.

‍

‍

‍

Want to stay apprised of the latest Judi Health / Capital Rx news? Sign up for our monthly newsletter!

‍

Interested in transitioning to an aligned and transparent pharmacy benefit partner? Click here to get in touch with our team!

‍

Disclaimer

This podcast is for informational and entertainment purposes only. The views expressed are those of our guests, do not constitute professional advice, and may not represent Judi Health's/Capital Rx's position on any matters discussed. We make no representations or warranties regarding the accuracy or completeness of the content; information is subject to change and may not be updated.

‍