Solving Challenges, Leveraging Opportunities

Public and Private Payor Coverage, Coding and Pricing Strategy

Public and Private Payor Coverage, Coding and Pricing Strategy

When clients are planning to introduce new products or services, McDermottPlus prepares coding applications and shepherds them through the ICD, CPT[1] and HCPCS processes. McDermottPlus then helps clients navigate the payor marketplace into which the new product or service will be sold, and develops and implements strategies to optimize the return on investment.

[1] CPT® is a registered trademark of the American Medical Association.

Representative Experience

  • Prepared clinical evidence dossiers to support coverage for new products at launch including a description of the clinical need for the new product, a description of the mechanism of action, a summary of clinical evidence, a summary of health economic evidence and regulatory status
  • Advised a global specialty pharmaceutical manufacturer on a large variety of issues related to drug coding, coverage and pricing
  • Prepared template reimbursement assistance documents to support the launch of new products pending adoption of new billing codes, including template letters of medical necessity, claim forms, procedure reports and bibliographies
  • Developed a coding, coverage and reimbursement plan for a life sciences company that is preparing to launch a novel treatment option for Parkinson’s Disease patients
  • Obtained a favorable Medicare clinical laboratory fee schedule rate for a diagnostic company that developed a test for a novel biomarker for heart failure
  • Consulted with an international pharmaceutical company on coverage issues for new prescription drugs

Case Studies