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Medical Device case studies

Medical Device case studies

Case studies

Our team has a deep understanding of the devices landscape, including public and private providers and payers, in addition to utilising the Open Sesame experience highlighted in the case studies shown here.


Reimbursement submissions & negotiations for the Prostheses List

Context

The Department of Health and Ageing administers a national Prostheses List. It regulates the benefit that private health insurers are required to pay for listed prostheses that are used in their members.

Actions

Prostheses List applications for a range of different product groups have been prepared and successfully submitted on behalf of several medical and surgical suppliers. Strategic reimbursement advice in addition to support with literature searches, clinical evidence, economic evidence and benefit negotiations have been key to the successful application process.

Outcome

A range of new prostheses have been listed on the Prostheses List, increasing sales of these prostheses used in private patients.

Optimal reimbursement of shaped wound dressings within the French reimbursement system

Context

The medical supplier had shaped wound dressings that were falling into a reimbursement classification that meant the out-of–pocket expenses for patients was significantly higher than for competitor dressings, leading to fewer prescriptions by General Practitioners.

Actions

A reimbursement submission was prepared based on a new technique of measuring the surface area of shaped and 3-dimensional wound dressings, combined with minor manufacturing adjustments and a supplier’s guarantee of specifications.

Outcome

The shaped wound dressings were listed in maximum size classifications, receiving maximum reimbursement prices.

Funding routes for pharmaceuticals

Context

he pharmaceutical company had a high cost orphan drug on the market, with a second one about to be launched, and was looking for a map of potential funding pathways for these drugs.

Actions

A comprehensive review of all public and private funding options for pharmaceuticals was conducted, including analysis of all state and federal budgets and programs that could potentially be sources of funding. These funding routes were mapped into a decision tree and a range of funding strategies proposed.

Outcome

A more informed company that is able to identify potential funding sources to assist its customers and patients.


Reimbursement of wound dressings on the RPBS

Context

The Repatriation Pharmaceutical Benefits Scheme (RPBS) is a government-funded reimbursement scheme for Veterans’ Affairs patients. The medical supplier wanted to make use of this reimbursement channel because a) no other formal reimbursement channels for these woundcare products existed and b) the demographics of RPBS beneficiaries matched their product range. The range of wound dressings reimbursed by the RPBS was extremely limited at the time.

Actions

A detailed reimbursement submission was prepared, based on RPBS submission guidelines, covering a wide range of wound dressings. I partnered with representatives of the medical company to personally present the submission to RPBS decision-makers, in conjunction with an education session on woundcare.

Outcome

A successful outcome was negotiated with the majority of products being listed on the RPBS, boosting sales to Veterans’ Affairs patients. The process helped to open up new reimbursement categories for wound dressings on the RPBS.

Funding submissions for a novel bio-engineered product

Context

The medical supplier wanted hospitals to allocate funds to cover the purchase of a set number of courses of treatment with a novel bio-engineered product. The product formed part of a revolutionary new therapy.

Actions

Comprehensive funding submissions were prepared for individual hospitals, incorporating case studies of their local experience of the product as well as a national retrospective/prospective cost analysis of therapy patients.

We partnered with key stakeholders within each hospital to identify potential funding pathways and lobby appropriate funding gatekeepers.

Outcome

Funding was obtained at the individual hospital level in many cases. In other cases, the stakeholder took the funding submission to State government level to successfully access funding pools such as New Technology Grants.

Cost Models

8A. Cost-effectiveness model.

Context

The medical supplier wanted to capitalise on the strong clinical evidence that differentiated their product from the competitors. This evidence was largely published in peer-reviewed clinical journals.

Actions

A user-friendly cost model was developed, using data extracted from the clinical papers, to show the relative cost-effectiveness of the product over its key competitor. The sales force was trained in the use of the cost model as well as basic health economic concepts. This helped them to address customers’ objections to a higher unit price by demonstrating cost-effectiveness.

Outcome

The credibility of the cost-effectiveness claims for the product increased, which led to an increase in sales. The sales force had a new tool in their toolbox to deal with price objections.



Reimbursement of a silver wound dressing on the U.K. Drug Tariff at a premium price

Context

The U.K. National Health Service (NHS) includes a government-funded reimbursement scheme for medical devices within it’s Drug Tariff. The medical supplier had a silver dressing with a price significantly higher than the silver dressing already listed on the Drug Tariff. The mission was to show that the dressing with the higher purchase price represented better value for money for the NHS.

Actions

Health economic data was designed and collected alongside the clinical trial of the dressing. The trial data was analysed to show where and how the supplier’s silver dressing was cost-effective compared with the silver dressing already listed on the Drug Tariff.

Outcome

The silver dressing was listed on the Drug Tariff at a premium price, resulting in increased sales volume with a healthy profit margin.

Reverse engineering reimbursement project

Context

The medical supplier wanted to maximise the reimbursement level of its woundcare product range throughout Europe. There were five key countries to be considered, each with their own criteria for reimbursement in terms of product specifications.

Actions

The reimbursement criteria at product specification level were compared and contrasted for all products in the medical supplier’s portfolio. The common elements were agreed and then actions taken on the elements where differences existed. In some cases a country-specific size of a product was manufactured to take advantage of the reimbursement size classifications. In other cases a component of the product was changed to retrofit the product into a more profitable reimbursement category.

Outcome

A range of woundcare products with minor modifications and maximum reimbursement levels in several countries.

Economic support for a medical device

Context

The medical supplier was seeking some economic evidence to support a marketing campaign for a novel medical device product used in hospitals. They wanted to capitalise on the environmental benefits associated with the use of their product, in particular water savings, as well as savings in nursing time and cost.

Actions

A primary research project was conducted to generate the economic data, including an observational time and motion study, a survey of nursing staff and desktop research. The evidence was presented as a report on the economics of current practice, which could be used as an evidence base for the marketing campaign.

Outcome

The economic report was quoted and referenced in the successful marketing campaign.

For further information please contact Joanne Burnett (Manager, Market Insight) on 0392510777 or at [email protected]

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