Building Payer Coverage: Do You Have the Tools?

The mantra, “if you build it, they will come” is one of that medtech developers overwhelmingly wish applied to third-party payers. In reality, however, payer coverage determinations are based on assessments of “medical necessity” – and implicit in these determinations are evaluations of comparative safety, effectiveness, and cost-effectiveness compared to the gold standard.

Health economics allows you to establish value, but how can you effectively communicate value to payers?

Value Dossiers

Value dossiers that summarize all comparative safety, clinical, and economic data on your technology, and are tailored to the unique payer perspective, are key in positive coverage decisions.

C-E Models and Value Dossiers: A Real-World Example

Our client’s technology could be utilized in a number of ways to aid in chronic disease diagnosis and management. Coverage of the technology, however, was only on a case-by-case basis. We proposed mining the client’s existing data to identify “stories” and value propositions that could be built. From this data, we identified 4 distinct applications in which value could be demonstrated. Four cost-effectiveness (C-E) models and a comprehensive payer perspective value dossier were developed. Additional communication pieces, including peer-reviewed journal articles, interactive models, and KOL training materials were also developed.

“Our contract payer relations team told us that these were the best C-E tools they’d ever worked with. Within several months we saw a significant increase in the establishment of favorable coverage policies.”

– VP of Global Medical Affairs, Large Diagnostics Company

Missing out on the opportunity to inform payers’ value assessments of your technology is often a huge, very costly mistake; payers are going to be assessing value with or without you guiding them. Wouldn’t you rather put your best case in front of them?

Need support in developing or communicating your value story? Contact us for value dossier development to drive stakeholder engagement and maximize your impact, leaving payers with no other choice than to say “YES.”