Technology Comparison For A Combination Product


Reimbursement Case Brief

A pioneering life sciences company is developing an innovative cancer surgery product that combines an imaging diagnostic and companion pharmaceutical. This product will alter workflows across three functions:

Nuclear imaging and radiology
Payment administration.

Company executives needed to define an appropriate reimbursement strategy, and clarify how that approach compares with competitive radiopharmaceutical and imaging technologies.

Our Role
Because this combination product will challenge the standard of care, our consultants conducted a comprehensive technology comparison. Specifically, we:

Investigated how payers and the medical community will evaluate the product.

Determined how medical specialty societies must align to define treatment guidelines and codes.

Considered whether quality measures, accreditations and payment redistribution resulting from work flow changes could influence provider adoption within a fixed payment procedure.  

Our research revealed that the clinical data must support a shift in treatment guidelines to secure payer coverage. We also created a clinical trial and development action plan to address key payment, health economics and pricing issues. This paves the way for hospital providers and physicians to support adoption.

We provided a vital blueprint for collaboration with key opinion leaders and trial sites. We also uncovered the economic considerations that must be highlighted to help hospitals understand the net financial benefit of adopting this combination product. Our efforts have helped the company target clinical trial sites and collect appropriate data to support treatment guidelines, coverage and adoption in a fixed payment environment.

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