Medtech market access breakthrough: Payer coverage expands for spinal implant

Client background

A global medical technology (medtech) company with annual revenues over $400 million develops devices designed to improve patient quality of life. With operations in multiple countries and a growing reputation in the life sciences sector, the company is committed to advancing therapies while ensuring patient access through expanded insurance coverage.

Business challenge

One of the company’s flagship products was a spinal stimulation implant for chronic lower back pain. Clinical studies showed the device delivered life-changing relief for patients who had exhausted other treatments such as medication, therapy or alternative pain management approaches.

Further research revealed that the implant could also treat painful diabetic neuropathy (PDN), a serious complication of diabetes that causes chronic nerve pain in the lower extremities. Expanding to this new indication represented an opportunity to help an underserved patient population, but the path forward was not simple.

Payers pushed back. Many insurers were hesitant to cover an expensive spinal implant for PDN, raising concerns about overuse, cost and whether the therapy was appropriate for lower extremity pain. Without payer support, patient access would remain limited and the company’s medtech market access strategy risked stalling.

Baker Tilly solution

The company engaged Baker Tilly to reshape how the therapy was presented to payers. The goal was to build a stronger, payer-focused narrative that reinforced the therapy’s value while addressing cost and utilization concerns head-on.

Working closely with leadership, Baker Tilly helped the company:

• Reframe the therapy as a last resort: Emphasizing that the implant would only be used after other treatments had failed reinforced the clinical appropriateness of the device.
• Address utilization concerns: Messaging was revised to assure payers that the device would not be overprescribed and that strict patient selection criteria would be applied.
• Highlight diligence in deployment: The company underscored its commitment to careful monitoring and targeted use, presenting the therapy as a responsible option for a clearly defined patient population.

By packaging the information in a way that directly acknowledged payer concerns, Baker Tilly helped the client strengthen its overall medtech market access approach and present a compelling case for expanded coverage.

Results

The results were immediate and measurable. The company secured new coverage decisions with five different payers, including both national and regional plans. This expansion opened access to more than 50 million additional covered lives, significantly increasing the number of patients eligible for the therapy.

For patients, the outcome meant new hope for access to a treatment that could relieve debilitating pain and improve quality of life. For the company, the success validated its revised payer strategy and demonstrated that communication, not just clinical evidence, can be the key to overcoming barriers.

The process also had lasting internal benefits. By aligning clinical, marketing and compliance teams around a unified payer message, the company strengthened its ability to pursue future indications and positioned itself more competitively in the market.

Conclusion

This case illustrates how success in healthcare innovation depends on more than scientific breakthroughs. The ability to effectively communicate value to payers is essential for improving access and adoption. By reshaping the messaging for its spinal stimulation implant, the company overcame insurer hesitation and achieved a major medtech market access milestone.

With expanded coverage, millions of additional patients now have the possibility of relief and the company has reinforced its position as a responsible innovator prepared to balance clinical impact with payer expectations.