Market access strategy turns payer resistance into national coverage

Client background

An emerging medical device company developed an implantable system to treat moderate to severe obstructive sleep apnea (OSA). The therapy was designed for patients who could not tolerate or use continuous positive airway pressure (CPAP), the standard of care for OSA. By offering an alternative for a difficult-to-treat patient population, the company sought to expand patient access and secure long-term adoption.

With annual revenues still in a growth stage, the company knew payer acceptance would be critical. A focused market access strategy would determine whether patients could benefit from the device at scale and whether the business could achieve broader market credibility.

Business challenge

Although the device had already achieved coverage decisions from several local and employer-sponsored health plans, the company struggled to break through with national payers. Without broader coverage, patient access remained limited, physicians had fewer prescribing options and investors questioned the company’s long-term trajectory.

The challenge was not evidence, the company had both clinical data and economic studies, but communication. The materials were scattered across multiple publications, leaving payers without a concise resource to evaluate value and outcomes. Bridging this gap was essential to capturing the attention of larger insurers.

Baker Tilly approach

Baker Tilly worked with the company to refine its market access strategy by strengthening both evidence presentation and payer engagement. The project began with a thorough review of clinical and economic studies supporting the implant, along with research on CPAP therapy and other treatment alternatives.

The team synthesized the information into a concise payer dossier designed to highlight the device’s clinical outcomes, cost-effectiveness and comparative value. By packaging the evidence in a streamlined format, the company could present insurers with the data they needed in a way aligned to their decision-making processes.

Beyond the dossier, Baker Tilly leveraged established payer relationships to ensure the message reached the right decision-makers. The team shared the dossier with national health plans and facilitated meetings between payers and providers of the therapy, allowing for open dialogue and direct discussion of value.

Business impact

The results were significant. Through this targeted market access strategy, the company secured national payer coverage for its implantable device. This decision expanded access to more than 50 million additional covered lives, giving patients across the country a new option for OSA treatment.

Coverage also provided a boost to investor confidence. Immediately following the announcement, the company’s stock price rose and has since remained stable, reflecting a stronger outlook for growth. The client is now equipped with a proven framework for ongoing payer discussions and future access initiatives.

Conclusion

This case illustrates the importance of pairing clinical evidence with strategic communication. By reshaping its market messaging and deploying a thoughtful market access strategy, the company not only achieved national coverage but also strengthened its credibility with payers, providers and investors.

With millions of new patients now eligible for treatment, the company is better positioned to deliver on its mission of improving outcomes for those living with obstructive sleep apnea.