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Met with senior policy leaders at key Medicare carriers to identify and assess
coding and coverage issues
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Identified coding strategy and submitted coding applications to the Centers for
Medicare & Medicaid Services (CMS) and the American Medical
Association (AMA)
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Met with professional specialty society and its coding representative to the
AMA to review and validate options for coding treatment
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Developed reimbursement and billing guides to help health care providers
understand reimbursement and coding options
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Met with senior policy staff at CMS to discuss options for addressing gaps in
patient access to the drug as well as reimbursement issues
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Trained sales force concerning major reimbursement issues and their possible
effects on providers
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Furnished physician practices with ongoing reimbursement support and
educational services
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Lash secured rapid coverage of the product despite a challenging reimbursement
environment.
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Physician practices regarded the manufacturer as a true partner in supporting
reimbursement and practice-related challenges.
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Developed a commercialization strategy within 90 days, working on consultative
basis with product team
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Helped transition more than 3,000 patients in clinical study group to market
use of the drug within a month of product launch
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Facilitated patient advocacy advisory board to assess strategic approach and
program before launch, and coordinated public affairs team
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Managed all aspects of registry and reimbursement referral program,
and coordinated activities with specialty pharmacy fulfillment program
until issues concerning limited product supply were addressed
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Facilitated formulary issues to speed patient access to drug
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Managed patient assistance and reimbursement services to prioritize needs of
uninsured patients, despite limited product supply
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Ensured that all patients who started therapy continued receiving product by
managing issues related to access.
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Expedited public payer coverage across the 50 states during the first 60 days
of product launch.
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Developed series of reimbursement education and practice management guides to
address specialty-related and treatment-specific obstacles to patient care
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Lash's consultants introduced reimbursement and practice management training
and tools at local and regional levels to support physicians, nurses, and
office managers
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Developed ongoing review and restructuring of reimbursement education modules
to continue to expand breadth and depth of program content
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Facilitated provider advisory board meetings to assess practice needs and
obstacles to patient access to care
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Lash's services were a key component of the manufacturer's strategy to support
market growth
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Physicians, nurses, and office managers were better equipped to resolve
reimbursement and practice management issues
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Conducted comprehensive reimbursement assessment and crafted strategy to
support preparations for product launch, including coverage profiles for
competitors' products for the top 150 payers nationwide
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Designed support services for patient access and provider
reimbursement—the foundation for the manufacturer's patient acquisition
and retention strategy
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Helped ensure clinical trial patients could continue on therapy as they moved
to market use of the product
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Created reimbursement and billing guides to help patients and providers
understand options for reimbursement and coding
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Developed and managed web-based services to support product team members in the
field, including access to Lash Group's proprietary database PayerPlus™
and reporting of product-specific payer activities
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Product reimbursement and formulary issues were minimized, speeding
up patient access to the drug.
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Access of field-based sales force to PayerPlus™ and product-specific
payer activities alleviated formulary and payer issues. Sales force
could view real-time payer data on specific products, including coverage,
payment, and utilization restrictions.
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