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Product Reimbursement
Avalere Health specializes in crafting creative and practical solutions to complex pharmaceutical, biotechnology, and
medical device reimbursement issues. We know how to navigate managed care formularies, pharmacy and therapeutics
committees, the federal bureaucracy, Medicare carriers, medical facilities, patient groups, and professional specialty
organizations to optimize your chances for positive coverage and payment decisions. We advise companies at all phases
of the development process - from pre-clinical assessments of likely market sizes to post-launch problem solving at the
institutional level.
We work closely with our clients to devise strategic answers. We offer close familiarity with the policy environment that
shapes the healthcare system, senior level contacts in government and industry, and extensive expertise in commercialization
of new technologies. Our work will help you decrease time to widespread adoption; create a favorable environment for
coverage and reimbursement; and enhance relationships with key stakeholders.
We focus on:
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Market Evaluation: Evaluate market demographics, payer mix, site of service, and reimbursement of precedent and competing technologies. |
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Coverage: Determine how to optimize public and commercial payer coverage across sites of service, product types, and indications, including identifying key clinical endpoints, preparing coverage requests, and compiling evidence tailored for key decision-makers. |
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Coding: Determine coding needs and options and identify and implement strategy for achieving optimal coding. |
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Pricing/Reimbursement: Estimate expected reimbursement of new products and identify strategy for obtaining adequate reimbursement to support desired pricing. |
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Guideline Development: Identify opportunities for guidelines development to support coverage/reimbursement of new technology. |
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Product Support: During launch and post-launch, identify customer needs related to reimbursement and develop efficient and effective programs to support priority needs. |
Our reimbursement team is reinforced by Avalere Health’s analytic, commercialization, and policy professionals, who provide needed data, key insights on market trends, and an understanding of the practical impact of public policy decisions on the commercial sector.
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