Gerard Rivera examines how copay programs and real-time gross-to-net (GTN) revenue protection can work together to support patient access and program performance. He highlights how simpler program design, timely data, and responsive action can help manufacturers manage affordability programs while preserving patient experience.
To learn more about RIS Rx's gross-to-net (GTN) revenue protection solution, get a custom GTN assessment from RIS Rx.
Read on for Gerard's insights.
Copay + GTN Revenue Protection = Better Together
By Gerard Rivera, Co-Founder & CEO, RIS Rx
That’s why we believe the best copay programs have something else working alongside them: real-time gross-to-net (GTN) revenue protection.
Think of the two as complementary systems. Copay helps patients access their medication. Real-time GTN revenue protection helps manufacturers see how those programs are actually performing — and act immediately before small issues compound.
The Best Copay Programs Keep It Simple
Our philosophy on copay starts with a straightforward principle: simpler is better.
Map the prescription journey from enrollment through fulfillment and you’ll find plenty of drop-off points. It can be tempting to address every one with another rule, another intervention or another layer of logic.
A better approach starts with the biggest source of friction. If patients are enrolling but never filling, look upstream. Is there a lack of price transparency at the beginning of the journey? Could solving that issue eliminate several downstream problems at once?
The smartest copay programs prioritize the changes that can make the greatest impact. So before changing a business rule, ask: How will this affect the patient? Could it create disruption? And if so, how can we mitigate it?
That’s where data can replace assumptions with answers.
Data = More Impactful When It’s Real Time
Even beautifully designed copay programs can't be put on autopilot in today’s rapidly evolving ecosystem. How can manufacturers stay ahead of the curve?
In our experience, three signals matter most:
Fill rate, by cohort. The single best indicator of whether affordability dollars are converting into therapy. On one large subcutaneous biologic program, active patients under active RIS Rx management filled 95.5% of the time since program inception — more than six points above the industry average for the category.
Segmentation accuracy. Aggressive protection only works if the right patients are identified. On that same large RIS Rx program, maximizer identification accuracy outperformed every industry benchmark we’ve measured against, with rare misses quickly corrected and patient access preserved. Without that data, anecdotes from the field can derail a program that’s actually working.
Claim-level behavior. For both retail and specialty distribution, claims analysis is key for visibility. Across two GLP-1 therapies, RIS Rx’s real-time, PharmD-driven claim monitoring drove over $120 million in cumulative cost avoidance over two years, cutting copay benefit spend by more than 45%.
The common thread in all these examples: each signal decays in value with every week of delay.
When Moving from Visibility to Action, Speed Matters
Real-time visibility only creates value if you can act on what you see. That’s why speed has become one of the most important characteristics of a well-run copay program.
We’ve seen situations where a needed business-rule change can take a legacy processor months to implement. This can translate into tens of millions of dollars in unnecessary exposure. It can also create avoidable patient disruption.
The alternative is a much tighter feedback loop: identify an issue in the data, determine the appropriate response, get manufacturer approval, implement the change that day, and immediately begin measuring the result. Adjusting rules this quickly can dramatically reduce unnecessary exposure without sacrificing conversion or patient experience.
Patient Experience and Program Performance Can Work Together
One of the biggest concerns we hear when manufacturers consider more aggressive GTN protection: Will patients suffer? It’s an important question. It’s also why assumptions need to be tested against data.
In one large RIS Rx program, patients with traditional benefit design filled approximately 65% of the time after enrollment. Patients affected by maximizer strategies, where the manufacturer had real-time GTN revenue protection in place, filled approximately 75% of the time. In other words, the more actively managed cohort had a fill rate 10 percentage points higher.
With the right data, manufacturers can understand how a change actually affects patient behavior, then refine it accordingly. Putting patients on the right path, helping them understand their benefits, and making the program easier to navigate can improve both program economics and patient experience.
Better Together: Get Your Copay + GTN Assessment Today
Copay programs and GTN revenue protection work best in concert. Copay gets support to patients. GTN revenue protection provides the visibility and intelligence to understand where those dollars are going.
As manufacturers evaluate their copay strategy, there’s one key question worth asking:
Does your GTN revenue protection partner understand copay well enough to help make your program better? The answer can have a direct impact on both patient access and program performance.
See where your program can work harder with a custom GTN assessment from RIS Rx.
About RIS Rx
RIS Rx is a healthcare technology company delivering gross-to-net (GTN) revenue protection for the world’s leading pharmaceutical manufacturers. Through proprietary software, real-time analytics and pharmacist-led expertise, RIS Rx helps clients optimize operations, eliminate leakage and ensure that financial assistance reaches the patients who need it most. RIS Rx is on track to protect $1.4 billion in revenue for its customers in 2026. Founded by pharmacists and headquartered in Irvine, California, RIS Rx serves leading pharmaceutical manufacturers across a growing portfolio of drug brands.
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