Reimbursement Landscape Assessment
WHY IS THIS IMPORTANT?
Success in the marketplace depends on developing (and executing) a systematic reimbursement and market access strategy as early as possible.
Knowing whether to go for a national coverage (NCD), regional Medicare Administrative Contractors (MACs), or a payer roadshow (and which ones to approach first) is a multi-faceted decision pathway based on type of product, the ability of the available evidence to meet payer-specific thresholds, and the quantity of specific types of evidence, among many other factors.
Different reimbursement pathways carry different levels of risk and cost; having a plan informed by reimbursement experts and payer intelligence is a critical part of a market access plan.
DID YOU KNOW?
Regulatory approval nor coding by itself guarantees reimbursement. Reimbursement is a 3-legged stool: coding, coverage, and payment. Payers make coverage and payment determinations through Health Technology Assessments (HTA) – and in the US, there is no universally set standard for HTA; every payer has their own process.
Support from key opinion leaders (KOLs) is instrumental to reimbursement.
Alternative pricing and payment models are taking off. As payers update their policies each year, there continues to be more and more transition from the traditional fee-for-service model to a value-based system.
HOW WE CAN HELP
If you’re unfamiliar with the US healthcare reimbursement system, our experts can provide you with a reimbursement landscape – a high-level overview of reimbursement (coding, coverage and payment) in the US – explaining how it pertains to your product and the need for all elements to come together for consistent reimbursement.
If you’re already familiar with the reimbursement system(s) within your target marketplace(s) and would like to understand how your product fits into the general landscape, our experts can conduct a reimbursement review with considerations for future reimbursement.
If you require support in developing a successful reimbursement strategy, our experts can conduct reimbursement assessments or review findings from existing assessments and build and convene payer advisory boards (comprised of current and former medical policy influencers and decision-makers) to develop or assess and validate your strategy, helping to identify appropriate sources of coverage, define the elements of reimbursement (coding, coverage and payment) as well as potential reimbursement pathways, and refine payer implementation timelines for your technology. We’ll detail specific actions and data elements required to obtain reimbursement of your technology as it pertains to its indicated use, identifying any data gaps in planned, ongoing or previous studies to ensure a winning reimbursement strategy with the best possible data package for your technology in order to support payer coverage and market access.
Insights
Have You Thought About Funding?
Have You Thought About Funding? Funding shouldn't be standing in the way of [...]
Reimbursement and Health Economic Assessments
Reimbursement and Health Economic Assessments [Regenesis Biomedical] In order to fully assess and [...]
Clinical Evidence Generation Strategy & Implementation
Clinical Evidence Generation Strategy & Implementation; Revenue Generation Roadmap Development [4Dx] 4Dx needed [...]
Obtain Favorable Reimbursement