The GIRS Payer Advocacy® (PAC) Team began working with a significant Payer in the New York area in April 2018 to obtain positive coverage and appropriate payment for a breakthrough medical device that was experiencing consistent denials for coverage. By July 2018, the GIRS PAC team obtained positive coverage, appropriate payment, and an ongoing communication with the Payer’s Chief Medical Officer and Policy Review team for continued coverage.
The GIRS PAC team conducted comprehensive research that involved establishing contact with the payer, reviewing relevant medical policies, and then creating key strategies for obtaining coverage and payment. Then, the GIRS PAC team thoroughly analysis the applicable medical policies and conducted discussions with the payer that facilitated an opportunity to establish positive coverage for our client’s product. A payer dossier was sent to further educate the payer.
As a result of the policy monitoring, policy analysis, and payer education, the GIRS PAC team obtained and verified positive coverage for this payer’s New York market, allowing access for a breakthrough medical to over 4 million patients.
Additionally, the GIRS PAC team developed tools to educate the client’s sales force and key stakeholders of the new, positive coverage, as well as made strategic recommendations to educate and support providers to reduce roadblocks in complying with the new medical policy.
Unless all key stakeholders are educated and the sales force communicates the positive coverage safely to accounts, this positive outcome will not automatically result in improved patient access and market uptake.
Do you have a medical device that needs improvement of market access? Are your devices facing negative coverage and payment issues and you are not sure where to begin? The GIRS Value Discovery Landscape Assessment® team can conduct a Landscape Assessment to develop payer desired strategies with current medical directors and the PAC team can implement these strategies to obtain positive coverage and appropriate payment. Call Us at: 1-844-514-4477 for more details!