Client Overview
Our client, a small biotech firm, is launching an innovative intracanalicular insert that delivers an anti-inflammatory medication after cataract surgery. The success of this product hinges on securing separate reimbursement payments from CMS and commercial payers for both the insert and its insertion by healthcare providers, while also building provider confidence.
Challenge
The client faces the critical challenge of navigating the reimbursement landscape to ensure financial viability and market access for their product. Achieving separate payment approval and fostering provider trust are essential to drive adoption and ensure a successful launch.
Our Solution
- Conducted an exhaustive analysis of analog reimbursement strategies to identify ideal reimbursement options for the client’s product: Product C Code and Category III procedure code
- These codes allowed providers to receive payment for an in-office administration and differentiated the product from competitors.
- Herspiegel also supported the client in applying to CMS for these codes
- Developed the business case and implementation plan for field reimbursement services (included HUB services, field messaging and customer engagement survey), and once approved, managed implementation
Value Delivered
- Differentiated the product in the market by obtaining critical reimbursement codes that facilitated payment for in-office administration
- Effective customer engagement and support post-launch through the execution of a well-planned field reimbursement strategy
- Achieved a 60% increase in treated patients, exceeding initial launch expectations with a winning reimbursement strategy
