Provider Reimbursement Education for an Expensive Biologic

Client:
A Large Pharma company manufactured an expensive biologic for physician-administered oncology treatment. Customers complained they were not receiving appropriate reimbursement to cover the costs associated with the product and threatened to discontinue using it.

Challenge:
The manufacturer needed to address its customers’ reimbursement concerns because these issues were beginning to keep patients from having access to the treatment. Also, because this physician-administered drug was in a crowded oncology market, the client needed to set its product apart from the competition.

Xcenda’s Action:
Xcenda conducted market research with physicians and payers to identify the specific reimbursement issues impeding patient access to the drug and to identify the most useful services and resources to help practices address these issues. Xcenda also conducted a competitor analysis to identify services and resources available to customers to assist the manufacturer with building a best-in-class service offering.

Based on this research, Xcenda developed a customized, solutions-based, educational service offering for the manufacturer’s customers that leveraged our expertise in practice management and oncology. Xcenda used a modular approach to develop content for live programs delivered to physician offices and hospitals. These modules addressed basic reimbursement principles, such as appropriate coding and claims submissions, and more advanced topics, such as improving office efficiencies and contract negotiation considerations.

As part of the program delivery, Xcenda assumed responsibility for scheduling and coordinating the venues and speakers for the programs. Xcenda also developed other resources including a coding tip sheet and billing guide that helped promote the educational programs and other services provided by the client, such as support lines and web portal.

Finally, Xcenda developed and conducted live training for the sales force to ensure that the representatives understood the resources available and how to use them most effectively. The training was conducted within a large sales meeting. After the sales force was trained on the services they could leverage when selling to their accounts, the representatives recruited their customers to the programs. Speakers were assigned based on need or specific requests. The educational programs were delivered through live programs, teleconferences, and web cast. Xcenda speakers presented at the physician office, the hospital, or an off-site venue such as a restaurant for single or multiple practices. The sales force also provided physicians and hospitals written materials, including the billing guide and tip sheet, and referred them to the web portal and support line for additional reimbursement questions.  For more information on patient support programs, visit our sister company, Lash Group.

Additionally, as a result of questions brought up during these live educational programs, Xcenda provided ongoing ad-hoc consulting on payer and legislative policy, such as changes to drug reimbursement, drug administration coding and reimbursement, the Centers for Medicare and Medicaid Services (CMS) payment mechanism, and private payer trends.

Results:
Over the span of 1 year, Xcenda conducted approximately 420 live programs and teleconferences. The client’s customers viewed the company as a true partner in removing barriers to patient access. The programs and resources increased awareness of the reimbursement challenges and provided practical suggestions for addressing these issues. Equipped with a new message to deliver, representatives were able to penetrate markets that were previously off limits.