Not everyone with a question about MS wants to address it to a screen or an algorithm. In preparation for the Copaxone 40mg
launch in January, Teva hired an additional 100 people to work in the company's Shared Solutions group, and also added sales
reps at a time when other parts of the company are shedding positions.
Shared Solutions was originally an independent third party patient services company, based in Kansas City. Teva acquired the
group in 2002, and every executive interviewed for this article—internally and externally — pointed to Shared Solutions as
a critical component of Copaxone's success. Anyone with MS, not just Copaxone patients, can use Shared Services free of charge.
"The key, I think, in the launch and success throughout the 17-year history of Copaxone has been Shared Solutions," says Derkacz.
Shared Solutions is focused on three areas: assisting patients in getting access to therapy; providing one-to-one injection
training to make sure patients have the best experience possible; and promoting adherence.
Shared Solutions has a call center component, where registered nurses answer inbound calls on a 24/7 basis, and also make
outbound calls to patients who have signed up to receive them. There's also a field component, where nurses provide injection
training at the doctor's office. Derkacz says physicians really appreciate this service. "They don't have the time or resources
to do all of this training and hand-holding and educating that we can do for the patient [through Shared Solutions]," he says.
Patients like it, too. Derkacz and Nancy Leone, communications director at Teva, say patients form relationships with the
nurses at Shared Solutions, sometimes over years on therapy. Teva has staged meetings at headquarters between patients and
nurses who have bonded through Shared Solutions, to dramatic result, says Leone.
Patients are connected with Shared Solutions when they receive the first Copaxone prescription, and the group makes sure there
aren't any hiccups in timely access to the drug. Shared Solutions is supporting the campaign to switch Copaxone users to the
new formulation by answering questions, and placing calls, to patients who've opted in to the program, says Hassler.
Access to therapy
Copaxone enjoys "the best formulary positioning across the entire category, meaning that we have the least number of NDC blocks,"
says Derkacz. "You're talking 98% open access to this product." Teva offers a $0 copay option for eligible patients, as well
as other kinds of qualified financial assistance. Asked about the CMS reversal and decision not to block copay assistance
from drugmakers under Medicare plans, Derkacz said it was the right decision."We know that high co-pays have a negative impact
on patient adherence...co-pay assistance can help achieve improved outcomes," he says.
The new Copaxone 40mg formulation is priced at 2% below the current price of Copaxone 20mg, a clear play at winning over the
sympathy of payers, who may soon be forced to choose between a daily injection of generic Copaxone, or a three-times weekly
version that would cost a good deal more.
On the question of whether payers might force patients onto the generic version of Copaxone 20mg (assuming a generic version
is approved by FDA), rather than pay for the more convenient 40mg dose, Derkacz says that's not what Teva has been hearing
from payers so far. "We're talking ethics here," says Derkacz. "How do you take a patient who has 200 fewer shots a year and
then push them not only back to a once-daily formulation, but one that's unproven?" Teva has expressed doubt, in print and
at just about every other opportunity, over the comparative effectiveness and safety of generic Copaxone.
Hassler says Teva expects to switch 30% to 50% of its current Copaxone 20mg patients to the 40mg version. Copaxone 40mg is
the same glatiramer acetate discovered in Israel over 30 years ago, but not the same product; Hassler says the switch campaign
boils down to this message: "We've taken the number one product in the market place, and we made it better."