A pharmaceutical manufacturer preparing to launch a new antibiotic in the inpatient hospital setting faced a significant reimbursement barrier. Under Medicare\u2019s Inpatient Prospective Payment System (IPPS), hospital services are paid through bundled Medicare Severity Diagnosis-Related Groups (MS-DRGs). Because the antibiotic was a new product, its cost was not reflected in existing MS-DRG payments, leaving hospitals with no clear reimbursement pathway. Without a solution, hospitals would face financial disincentives to adopt the therapy, jeopardizing patient access.<\/p>\n\n\n\n
The client turned to Applied Policy to identify a strategy for Medicare coverage and payment. Applied Policy recognized the New Technology Add-On Payment (NTAP) as a mechanism to provide temporary, separate reimbursement for the drug until its costs could be incorporated into the MS-DRG system. Just as importantly, we understood that successful commercialization depended not only on reimbursement being available, but also on hospitals having the knowledge and resources to bill Medicare correctly for the product.<\/p>\n\n\n\n
Applied Policy prepared and submitted the NTAP application, securing approval for separate inpatient payment. We also drafted potential language for provider-facing materials, identified agency contacts to engage in outreach, and engaged with CMS on the development of a Medicare Learning Network (MLN) article specific to the product.<\/p>\n\n\n\n
The outcome was twofold: hospitals were able to obtain separate Medicare reimbursement for the antibiotic through NTAP, and CMS-issued provider guidance supported hospitals in adopting its use. Together, these efforts expanded patient access to the therapy and gave providers the clarity needed to incorporate it into inpatient care.<\/p>\n","protected":false},"excerpt":{"rendered":"
A pharmaceutical manufacturer preparing to launch a new antibiotic in the inpatient hospital setting faced a significant reimbursement barrier. Under Medicare\u2019s Inpatient Prospective Payment System (IPPS), hospital services are paid through bundled Medicare Severity Diagnosis-Related Groups (MS-DRGs). Because the antibiotic was a new product, its cost was not reflected in existing MS-DRG payments, leaving hospitals […]<\/p>\n","protected":false},"featured_media":8463,"template":"","categories":[428,433],"ap4_case_study_category":[],"class_list":["post-10074","ap_casestudy","type-ap_casestudy","status-publish","has-post-thumbnail","hentry","category-life-sciences-companies","category-navigating-cms-rules"],"yoast_head":"\n