Pre-launch Reimbursement Strategy for an Oncology Product

Client:
A small pharma company had an anti-emetic agent in development that, despite a subcutaneousroute of administration, would likely be physician administered in office and hospital outpatient settings. The product had proposed indications in oncology and had shown great clinical potential in development, with several larger pharmaceutical companies considering partnership opportunities.

Challenge:
Understanding the reimbursement outlook is critical to a product’s success. Without appropriate coverage, coding, and reimbursement mechanisms in place, access to the drug will be negatively impacted through delays in claims processing, inappropriate payments, and overall low product utilization. Accordingly, the client wanted to outline the potential reimbursement scenarios for this new drug in order to demonstrate the full value and potential to prospective investors. Specifically, the client sought to define the key coding, coverage, and reimbursement scenarios for both public and private payers within the context of the current healthcare policy environment.

Xcenda’s Action:
Using our experienced team of reimbursement and health policy experts, Xcenda conducted a comprehensive reimbursement analysis, identifying Medicare and private payers as the key payers for this drug. In its analysis of Medicare coverage rules, Xcenda identified existing national and local policies that could impact coverage of the drug and highlighted differences in how local contractors may utilize restrictions for use and coverage of self-administered vs physicianadministered anti-emetics.

Through its exclusive network of private payer decision makers, Managed Care Network, Xcenda conducted market research and assessed potential coverage and payment issues for the commercial payer segment.  Xcenda's managed markets team also tested proposed pricing and contractual details. In addition, the team developed a comprehensive analysis of reimbursement implications for competitive products for both Medicare and commercial payers. 

Finally, Xcenda identified main challenges and opportunities for the client’s drug to help maximize market access. After outlining key reimbursement milestones in the development process, Xcenda provided reimbursement recommendations and strategies that the client may need to undertake in order to prove product value and viability to potential partners.

Results:
The reimbursement analysis helped the client understand the key reimbursement strengths of its product. Identification of reimbursement barriers along with suggested actions to overcome them also helped the client anticipate and prepare for questions from potential partners. Key components of the report were transported into the client’s business plan to help drive the company’s continued success.