Reimbursement & Policy Insights

Reimbursement data on touchscreen

Maximize patient access at every stage of the product lifecycle.

Clients count on our reimbursement and health policy expertise to develop strategies that adapt to the changing payer environment and ensure appropriate patient access. Whether it’s designing provider tools that break down complex billing and coding, or educating provider offices on how to proactively position for legislative and regulatory updates, Xcenda’s RPI team has the knowledge, experience, and client service skills to create and implement effective strategies for success. 

Patient and Provider Access Strategy

Build a comprehensive reimbursement and launch strategy

The right combination of patient assistance programs, reimbursement, and copay support programs requires a delicate balance of maximizing access while supporting strategic brand imperatives. Our experts are ready to explore the dynamics of access and reimbursement across any site of care, from the physician office and hospital to long-term care and within patients’ homes. Partner with us to design the optimal support solution based on your patient population’s specific needs.

Benchmarking Analyses

Understand the competitive landscape, explore innovative solutions when looking to other therapeutic areas, and identify likely expectations of key stakeholders.

Exposure Analyses

Estimate patient participation, project budgetary needs, and evaluate the impact of different program designs to conduct cost-benefit analyses.

Multidisciplinary workshop

Facilitate discussions and get alignment from all stakeholders on strategy, setting expectations, and ensuring successful pull-through of key tactics.

Market Research

Gain actionable insights about the needs and expectations of both patients and practice managers through first-hand interviews with customers. 
Datasheets on a table

Reimbursement and Policy Analytics

Inform your patient access strategies with evidence-based insights

Datasheets on a table
Our reimbursement and policy analytics team provides clients with a deeper understanding of health policy implications. Using detailed data analyses, including market assessment, payment system modeling, budget scoring, and payer and formulary analyses, our team delivers evidence-based insights and recommendations that help increase patient access. 
Datasheets on a table

Payer Segmentation

Know where to focus payer communications for optimized access

Coverage can vary greatly — not just from payer to payer, but also from state to state. We complete necessary payer research to identify specific dynamics, such as utilization management requirements and payer behavioral characteristics. By identifying the current reimbursement environment for individual products and mapping out dynamics across a therapeutic area over time, our experts formulate and execute on plans to help you focus resources for key results. 

Avoid the J-code black hole  

In today’s increasingly tight margins, no one can afford imperfect coding. The repercussions of incorrect coding, denied claims, and reimbursement delays can have an unacceptable impact on speed to therapy. Let our team of certified coders help you understand current product codes, evaluate different coding options, and provide support with new code applications to ultimately maximize patient access.
Healthcare professional working on laptop
Compendia Strategy

Develop a compendia strategy to guide coverage decisions

Understanding appropriate patient access to needed treatments for non-labeled indications requires a strategic approach to compendia. Turn to our experts in compendia strategy to develop materials that help influence and guide coverage decisions affecting prescribing behaviors and patient access.

Our approach includes:

  • Compendia Benchmarking Analysis

  • Benchmarking Analysis

  • Gap Analysis

  • Submission Package

  • Surveillance

  • Payer Utilization and Trends Analysis

Develop the knowledge - and share it

Reimbursement Training

Gain deeper understanding into how reimbursement affects all stakeholders, from patients and providers to payers and manufacturers. Xcenda develops and facilitates a training curriculum that is driven by the roles and responsibilities of each audience. Every engagement is customized to fit the client's product, disease state, learning objectives, audience, and training modality.

Receive training on a wide array of topics, including:

  • Healthcare coding, coverage, and payment
  • Managed care fundamentals and trends
  • Value-based payment and quality initiatives
  • Medicare and Medicaid
  • Health policy and healthcare reform
  • Practice efficiency 
  • Payer contracting and private payer trends
  • Manufacturer-sponsored patient support programs 
  • Distribution channels (MCOs, PBMs, GPOs, hospitals, specialty pharmacies)
  • 340B

Reimbursement Tools

Building on our reimbursement and access landscape expertise, Xcenda develops robust tools to support physician offices, hospitals, pharmacies, and others throughout the care continuum. Whether helping staff order products, submit optimized claims, or better facilitate patient assistance, we design user-friendly, easy-to-understand guidance materials. Our reimbursement experts work seamlessly with creative specialists to develop digital and printed tools designed to drive greater patient access to care. 

Develop materials that make a difference:

  • Billing guides
  • Flashcards, tip sheets, and brochures
  • Enrollment forms
  • Launch toolkits
  • Digital tools
  • Sample claim forms
  • Videos
  • Hub branding

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We’re value drivers and problem solvers. Let us connect you with experts who understand your world and what success demands.
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