Reimbursement & Market Access

Atheln experts focus on the integration of pricing, reimbursement, and market access when identifying the impact on a product’s development and commercial strategy

In today’s evolving market landscape, understanding reimbursement and market access early in development and its implications on development plans are critical for a product’s future commercial viability. Building a phase appropriate pricing and reimbursement strategy and understanding the implications of potential market access opportunities and challenges are a key component of each product’s go-to-market strategy and a key focus area for investors and strategic partners.

Reimbursement is about effectively conveying the value of a product to the health care system and providers. This requires generating and communicating compelling clinical and health economic data and understanding who will be the payers of a product and their impact on future uptake. Evaluating the coverage and reimbursement landscape early in development can influence a product’s Target Product Profile (TPP) and affect a product’s development plans. The goal is to develop a TPP which supports a product’s value proposition for multiple target audiences including payers.

Atheln focuses on developing a deep understanding of the value of products to patients and the healthcare system and to communicate this to payers. Payer insights are generated through payer interviews and payer analysis for different scenarios. 

Based on these assessments and research, Atheln develops phase appropriate strategies and plans and can support the implementation of these plans.

Atheln experts focus on the integration of pricing, reimbursement, and market access when identifying the impact on a product’s development and commercial strategy. Their experience provides a unique blend of developing and implementing pricing, reimbursement, and market access strategies at all phases of development while in small to large biopharma, medtech, and diagnostic companies and as consultants. To fully understand the needs of payers, Atheln also has experts that held senior level positions in managed care organizations.

Atheln Reimbursement and Market Access services include:

  • Reimbursement Landscape: understand the current and future landscape for your product from a payer, physician, patient, and commercial point of view
  • Coverage and Coding: understand coverage guidelines for diagnosis and treatment options, need for HCPCS codes when appropriate, and develop phase appropriate strategies
  • Payer Insights: understand from payers the clinical and health economic data essential for reimbursement and coverage 
  • Target Product Profiles adapted to payer needs
  • Primary market research with payers (Health Plan/PBM Medical & Pharmacy Directors)
  • Value based reimbursement models: understand the value of products and services to patients and healthcare systems
  • Data- and evidence-based value story for payers to support pricing and market access
  • Health economics: analysis, modeling, and strategies and implications for clinical studies
  • Cost burden of disease
  • Pricing: scenario planning for pricing, contracting and reimbursement 
  • Market access: understand opportunities and barriers and develop strategies integrated with development and commercial plans
  • Reimbursement and Market Access gap analysis and roadmap based on clinical stage of development
  • Commercial, Medicare Part B + D, Managed Medicaid strategies
  • Formulary & Benefit Management Tracking