The Client: A Large, International Medical Device Manufacturer and Distributor
The Need: Market Uptake for Two Extracellular Matrices (ECM) Used in Managing Wounds
The Service: The GIRS Payer Advocacy Compass®
The Outcome: Positive Coverage and Improved Patient Access for a Michigan-based Health Plan
Our client distributes and markets two advanced tissue-repair products that are used in Wound Care Management to aid in the healing of various types of wounds. The GIRS Payer Advocacy Compass® (PAC) team began working with a regional health plan in the state of Michigan that includes commercial plans, a Medicaid managed care plan and two Medicare Advantage plans . The process of educating the payer about both ECM products process began in March 2013 and a payer-desired dossier with clinical and cost studies was also sent. The GIRS PAC team followed up with the payer until positive coverage was established in May 2018. The PAC team was further able to verify that the codes were covered, prior authorization was not required, and appropriate payment was available for all settings of care. The client was strategically advised to update their sales force and their Michigan accounts of the positive coverage and prior authorization requirements. Thanks to the diligent advocacy efforts of the GIRS PAC team, 650,000 people in the Michigan area now have access to this novel medical device and our client’s market share has increased in this important market.
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