Applied Policy has helped dozens of clients understand the environment in which they are launching, from how providers will be reimbursed for their product to securing the necessary billing codes to identify their product on claims. We have helped clients understand how similar products are covered, coded, and paid for currently by Medicare, Medicaid, and commercial plans. Because we are constantly scanning the policy landscape, we can also help assess any potential future changes that need to be considered. As a “full service” consulting firm, we don’t just send applications and forms for you to fill out and file independently, we work with you, using our long involvement with CMS, to develop a compelling application that is filed timely. We will also guide you through the consideration process and help you develop any public meeting materials in defense of your request.

Several Medicare payment programs also have special payment provisions for new products. We work with our clients to review and assess the benefits and risks of filing applications for these special payments. If the decision is made to file, we work with appropriate internal staff to complete and file all of the necessary paperwork.

Sometimes, when a company is launching a product that is unlike any currently marketed products, it is necessary to arrange meetings with agency staff in order to educate them about the new product and anticipate any potential obstacles. We work collaboratively with our clients and agency staff in order to identify mutually-beneficial outcomes so that patients have access to the products that they need to improve their lives.

The experienced Applied Policy team is ready to help you and your team prepare for a new product launch. Medicare national and local coverage policies frequently form the foundation of policies for other health plans. Our team can help with a thorough review of existing Medicare payment policies to determine reimbursement methodology, likely reimbursement amounts, and the potential for changes that could affect the new product launch. We can also help obtain appropriate coding for new products, including through classification to an existing code or applying for new codes. Special Medicare payment policies, such as pass-through payments, new ambulatory payment classifications, and new technology add-on payments will also be considered as part of a holistic access strategy. If appropriate, we are happy to help arrange meetings with agency officials to ensure awareness of new products and services and to confirm market access assumptions. Finally, we will make recommendations for collection of data and development of evidence prior to launch to support coverage, coding, and payment by Medicare and Medicaid after the product launch.