Strategic Approach to Insurance Coverage and Access

A strategic approach to payers begins with an understanding of the payer landscape and what you can do to create the right clinical program to achieve optimal coverage from the key payers in your area. We work closely with our clients to guide the development process to address the issues of most importance to payers.

 

Communication

Enlightenment Bioconsult creates customized payer advisory boards and panels as forums for obtaining payer feedback and understanding payer needs in order to ensure favorable clinical policy decisions and formulary placement for new products using new technology. This includes gene therapy, cellular therapy, novel small molecules and innovative drug/device combinations.

Internal Training and Board Presentations

Enlightenment Bioconsult is currently producing the PayerSpace(TM) Conference focused on bringing an understanding of the US insurance market to pharma and biotech firms. The first conference will be in Cambridge, MA on December 5, 2017.

Our CEO, Dr. Ed Pezalla, creates customized training solutions for firms with clinical stage products as well as speaking to senior directors and boards on health policy, US payment landscape, and Health Technology Assessment.

Strategic Planning

Payer strategy applies at all stages of the drug development process. We have helped clients from start-up to launch.

Start-up: investors want to understand the opportunity for access and utilization of new products. Is this a product for Medicare? Commercial?

Early Clinical Phase: will this pharmaceutical be accessed via medical or pharmacy benefits, what is the difference and why will it matter? Is there an opportunity to influence this decision?

Phase II to III transition: what data will be required by payers? How can you answer their requests for relevant clinical and economic information while pursuing the path set out by the FDA and EMA?

Dialog with Payers

Advisory boards, panels, and interviews are just some of the means we use to obtain information and advice from payers. This information informs and propels strategy so that you are ready for P&T Committee meetings, Health Technology Assessment activities. and Clinical Policy discussions

Next Steps...

Check out Dr. Pezalla's website for samples of presentations and to obtain his full CV.