Overcoming common market access and coverage challenges

Authored by David Gregory and Christina Cool

Baker Tilly discusses common problems with regard to market access and coverage for your technologies and some of the ways which we can help you address those issues.

The inherent skepticism that all technology is cost additive

First of all, Baker Tilly openly acknowledges that payers are naturally skeptical about new technologies. New technology has been available and promulgated for the last 25 to 30 years. Statistics will tell you that new technology is typically cost additive and payers have data that agrees.

Baker Tilly provides our clients with the tools to be able to overcome the inherent skepticism that all technology is cost additive.

We work very closely with our clients’ data, with the clinical information that we have access to and with our payer relationships to really deepen their understanding of how their story should be told. We help them tell that story, and then help them deliver market access for the patients that are going to benefit from their technologies.

Overcoming being deemed as experimental and investigational

Overcoming being deemed as experimental and investigational can be very hard for a number of companies. The best way you can overcome this is putting together a clear and concise story. The first thing you should do is put together a strong clinical dossier, including your randomized control trials and other clinical data. If you’re still having trouble here, you can go onto stage two evidence, which would include retrospective claims reviews, registries and other types of studies.

Another thing you need to do is to establish a clear economic story. This sometimes can help when the clinical evidence isn’t there, especially for smaller payers.

Medical societies are often overlooked; however, reaching out to medical societies and getting them to confirm that your technology is needed for patient care can be key.

Network noise

The last thing that we think is very helpful is network noise. This means making sure that physicians and patients are letting payers know that they need your technology or device.

Once you've put together clinical evidence, your economic evidence, work with societies and have created network noise your technology will be in a good position to gain access with payers. Lastly, payers are looking for this to be combined into a clean and concise dossier.

Articulating the cost of your device or technology

A fundamental challenge for our clients is how to articulate the cost of their device or their technology to payers. We can assist clients that have a device that's $25, $2,500, $25,000, or even $250,000.

Price does not matter to us. We have models and data and value proposition development capabilities that will certainly articulate the cost of the device and the value.

Communicating the price of your technology to the marketplace can be stressful. Baker Tilly can assist with all of your concerns and has the tools to help you tell your story.

For more information on this topic, or to learn how Baker Tilly market access specialists can help, contact our team.

Webinar: Achieving Payer Coverage (the who, what, when, where and HOW)