A more dynamic, data-driven approach is redefining what “good” looks like in copay support.
As the pharmaceutical industry continues to grapple with rising out-of-pocket costs, complex insurance designs, and increasing scrutiny on affordability programs, traditional copay models are being pushed to their limits. Manufacturers are under increased pressure to protect patient access while simultaneously managing gross-to-net performance and mitigating financial leakage from fraud, waste, and inefficiencies.
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Pharmaceutical Executive spoke with Brian Laird, president of patient services, who shared his perspective on how the market is evolving and new solutions like EVERSANA’s Intelligent Copay offering. Laird explains how a more dynamic, data-driven approach is redefining what “good” looks like in copay support.
Pharmaceutical Executive: How has the copay marketplace in pharma changed over the past few years?
Brian Laird: Much like a lot of parts of pharma, it’s fair to say the copay sector continues to rapidly evolve. Today, copay programs are no longer operating in a simple reimbursement environment. We’re seeing far more complexity driven by high-deductible health plans, accumulators and maximizer programs, and increased variability across payers and pharmacy benefit managers. What used to be a relatively straightforward affordability mechanism has become a strategic lever that directly impacts patient access and a manufacturer’s financial performance.
At the same time, expectations have shifted. Manufacturers want more transparency, more control, and better outcomes. And this is not just in terms of helping patients afford therapy, but in how those dollars are being spent and protected. Copay programs today need to be smarter, more resilient, and much more connected to the broader commercialization ecosystem.
What are the largest barriers companies face when considering a copay program?
Laird: One of the biggest barriers is the tradeoff manufacturers often feel forced to make between access and cost control. There’s a real concern that expanding affordability can lead to rapid spending, exposure to fraud, or limited visibility into where funds are going.
A second challenge we see across the board is infrastructure. Many traditional copay programs rely on single-vendor models or static adjudication pathways that simply weren’t designed for today’s level of complexity. When those systems fail, whether due to outages, policy changes, or evolving payer tactics, patients feel it immediately. Manufacturers are realizing that without flexibility and redundancy built into the model, even well-intentioned programs can fall short. And in the end, it’s patients that will hurt the most.
PE: Tell us why EVERSANA saw the need to launch a new copay solution?
Laird: We’ve been leaders in the copay space for a long time. To date we manage more than 80 active programs, process more than 12 million patient claims each year serving 1.5 million patients in America. We know what’s working and what must be improved.
We saw a clear gap between what manufacturers need today and what most copay solutions were built to deliver. Too many programs were still operating as transactional services instead of strategic financial tools.
That’s why we concepted and have just launched our Intelligent Copay Solution to fundamentally rethink how copay programs function. They must shift from a static, one-size-fits-all approach to a dynamic marketplace model. The goal was to give manufacturers more control over spend, better protection against risk, and greater confidence that patient access wouldn’t be compromised, even as the market continues to evolve.
PE: What roles does advanced technology like AI play in the new EVERSANA Intelligent Copay solution?
Laird: Advanced technology is foundational to how the solution works. Artificial Intelligence (AI) allows us to move beyond reactive program management and into a more predictive, proactive model. For example, we are using AI to identify patterns that indicate fraud, waste, or abuse before they impact the program at scale.
Technology also enables intelligent routing across multiple adjudication pathways, ensuring claims are processed through the most efficient and cost-effective option available at that moment. That level of real-time decision-making simply isn’t possible without modern data architecture and AI-driven analytics. It’s no longer nice to have. It’s a must.
PE: How does your solution work to help manufacturers navigate insurance, coverage and especially cost challenges they face when development benefit programs for employees?
Laird: Our approach is designed to meet manufacturers where complexity exists. Instead of forcing all claims through a single pathway, the Intelligent Copay Solution creates continuity throughout the patient journey, supporting patients where they are and giving them the best option.
Just as importantly, we provide transparency. Manufacturers now can see how their programs are performing, where funds are being used, and where optimization opportunities exist. This visibility allows them to make smarter decisions and balance patient support with sustainable program economics.
PE: What type of experience does EVERSANA bring to the copay sector in pharma? And what really sets you apart from others?
Laird: EVERSANA brings scale, depth, and integration that few organizations can match. We support millions of patients, process millions of claims each year, and operate across tens of thousands of pharmacies nationwide. I believe this experience gives us a unique vantage point into how affordability programs perform in the real world.
What truly sets us apart, though, is how deeply copay is integrated into our broader commercialization and patient services ecosystem. We’re not treating affordability as a standalone function. That’s the old way of working. Our programs connect to data, analytics, patient engagement, and program integrity. This holistic approach allows us to deliver better outcomes for both manufacturers and patients.
PE: What will copay programs look like in the next five years as they relate to creating greater patient access and a better experience?
Laird: Copay programs will continue to become far more intelligent, adaptive, and patient-centric. Static rules and manual oversight won’t be enough. Manufacturers will expect real-time insights, built-in safeguards, and programs that can evolve alongside payer behavior and policy changes.
Most importantly, the focus will continue to shift toward experiences. Patients don’t think in terms of copay mechanics. What matters to them is affordability, access and what they need to do to stay on therapy. In the years ahead, programs that succeed will be those that remove friction, maintain continuity, and do so in a way that’s financially sustainable. That’s the standard we as an industry must move towards, one that puts the needs of patients first while providing longevity for manufacturers.
