Market access strategy secures national payer coverage for implantable device
This case study highlights how Baker Tilly helped an emerging medical device company secure coverage of its implantable medical device from a national payer.
Client background
An emerging medical device company was struggling to obtain medical coverage for its device, an implantable system which assists in the treatment of moderate to severe obstructive sleep apnea (OSA) for patients unable to use or intolerant of the standard of care, continuous positive airway pressure (CPAP) therapy.
The business challenge
The client needed to combine its clinical and economic literature into a concise document for payer distribution. Although it had already achieved positive coverage from several local and employer plans, the medical device company had been unsuccessful in finding larger health plans to cover its device and bridge the conversations in a meaningful way with national payers.
The Baker Tilly approach
Baker Tilly reviewed and assessed existing clinical and economic studies in support of the company, as well as those relevant to the standard of care and alternative treatments. Following the review, Baker Tilly synthesized the evidence into one concise document, referred to as a dossier, to share with commercial payers. After creating the dossier, Baker Tilly utilized its contacts at various national payers to share the document and to facilitate dialogues and meetings between payers and providers of the therapy, in which they discussed the value of the device.
Business impact
Payer outreach activities on behalf of the company helped facilitate positive medical coverage for 50+ million members. Immediately after receiving coverage from the health plan, the company’s stock price increased and has remained relatively steady ever since.
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