Payer Reimbursement Landscape

April 21, 2016 BACK TO RESOURCES

OBJECTIVE:

Conduct a detailed Medicare, Medicaid and commercial coverage and payment analysis to assist the client with launch planning.

APPROACH:

Analyze Medicare national policy, select Medicaid states’ policies, and select national, regional and local policies for client product.

Examine local Medicare MAC policies or DMAC policies (key for DME, Dx, oral anticancer and supportive care products). If anticancer, evaluate impact of compendia coverage.

Conduct payer interviews to gauge likely hurdles and anticipate management.

OUTPUT:

  • Comprehensive analysis outlining the Medicare, Medicaid and commercial payer coverage and payment environment
  • Recommend strategy for Medicare, Medicaid, commercial coverage at launch

AUDIENCE:

Senior Executives, Policy and Reimbursement Executives, Brand Teams

USE BY CLIENT:

Determine launch and pricing strategies.