Our Process Works.

OUR PROCESS.

PREPARE + STRATEGIZE

Assess needs
Map patient + Rx flow
Identify patient problems and plan solutions
Determine KPIs and commit to benchmarks

DESIGN + IMPLEMENT

Connect with front-line staff
Develop HCP + patient messaging
Manage vendors for optimal performance
Execute programs
Anticipate C-suite data needs

COMMUNICATE + EVALUATE

Quantify return on objectives
Communicate with senior leadership team

Your results.

New Therapy,
New Reimbursement

Improve Service,
Reduce Spend

First-in-Class,
Competition Close Behind

Opportunity: New injectible
launching outside
Medicare-established case rate.

Brand challenge:

Comparable clinical efficacy among competing products and new insurance pathway requiring more effort from HCPs.

Patient challenge:

Commercially insured patients may need copay support for out-of-pocket costs towards product after their medical benefits have been applied.

Data points:

Clinical trial efficacy is comparable to oral medication already on market. Real world patient health outcomes are anticipated to be better with new product due to greater compliance with HCP administered injectible (during regularly scheduled treatment sessions) vs. patient-taken daily oral medication.
HCPs have not had to bill (or seek prior authorization) for a product outside the established disease area case rate in many years. KOL interviews indicate limited experience and high discomfort with coding and billing outside of treatment case rate.
For a multi-year trial period, providers may bill for new product and product administration separately as CMS reviews utilization and determines appropriate case rate increase (if any).
Commercially insured patients typically use employer-sponsored health plan coverage for ~ one year before qualifying for Medicare based on diagnosis.
Manufacturer already offers a reimbursement support hub for well-established product portfolios in this therapeutic area. Hub vendor has not been able to solve for repeated patient case backlog, nor can satisfactorily explain volume and inaccuracy of patient referrals to patient assistance program (PAP).

Recommendation:

Issue request for proposals (RFP) for a single vendor that can support the existing hub program, launch the new product’s hub, AND support a new field reimbursement team.
- Upon review, business awarded to a new partner with a six month transition plan (nine months before new product launch).
- Map FRM assignments against sites of care, not prescribers, as sites of care coordinate patient insurance coverage (often through centralized billing offices).
- Communicate FRM assignment rationale to manufacturer business unit sales leadership and involve them in FRM leadership interview panels.
Create a robust training program and core visual aid material detailing access and patient support services for the manufacturer sales team.
Re-format and refine patient enrollment form for access services.
Select copay vendor with well-documented systems that safeguard against providing manufacturer copay support to patients with government sponsored health plans. This is a significant concern, given the heavy Medicare use in this particular patient population.
Secure buy-in from manufacturer’s legal team:
- Permit the hub to automatically enroll (consented) commercially insured patients with coverage in the new product’s copay support program, and communicate the patient’s copay card information to the patient’s site of care as part of coverage determination fax communication.

Results:

Transition between hub vendors executed on time, under budget, and with zero systems failures.
Improved (de-identified) patient level reporting and health plan insights.
Prescriber uptake exceeded launch forecast.
High copay card utilization (>80% eligible patients used card at least once).

Our Process Works.

OUR PROCESS.

PREPARE + STRATEGIZE

DESIGN + IMPLEMENT

COMMUNICATE + EVALUATE

Your results.

New Therapy,
New Reimbursement

Improve Service,
Reduce Spend

First-in-Class,
Competition Close Behind

Opportunity: New injectible
launching outside
Medicare-established case rate.

Opportunity: Mature Specialty Brand launching new companion device without increasing Patient Support spend

Opportunity: Novel therapy serving high unmet need.

Our Process Works.

OUR PROCESS.

PREPARE + STRATEGIZE

DESIGN + IMPLEMENT

COMMUNICATE + EVALUATE

Your results.

New Therapy, New Reimbursement

Improve Service, Reduce Spend

First-in-Class, Competition Close Behind

Opportunity: New injectible launching outside Medicare-established case rate.

Brand challenge:

Patient challenge:

Data points:

Recommendation:

Results:

Opportunity: Mature Specialty Brand launching new companion device without increasing Patient Support spend

Brand challenge:

Patient challenge:

Data points:

Recommendation:

Results:

Opportunity: Novel therapy serving high unmet need.

Brand challenge:

Patient challenge:

Data points:

Recommendation:

Risk:

Results:

New Therapy,
New Reimbursement

Improve Service,
Reduce Spend

First-in-Class,
Competition Close Behind

Opportunity: New injectible
launching outside
Medicare-established case rate.