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Case Study – Working with Congress to Prevent Harmful Medicare Reimbursement Cuts

Case Study – Working with Congress to Prevent Harmful Medicare Reimbursement Cuts

Through collaboration with the client, K+A created an influence map: identifying Members of Congress where the coalition had physician members and/or a treatment facility and cross-referencing the map with Members of Congress with jurisdiction over Medicare. We educated these offices on the issue and the potential impact to their district or state. After the initial meetings, we coordinated any follow-up communications and worked with the client to provide additional materials to these offices. We also monitored the Administration’s efforts to promulgate the Physician Fee Schedule final rule, and prepared for further engagement with Congress in the event of any potential decision by the agency.

Issue:

A coalition of stakeholders wished to inform and engage Members of Congress about proposed Medicare cuts for an innovative medical device.

Outcome:

Multiple Members of Congress weighed in with CMS to oppose the reimbursement changes. The agency acquiesced to this feedback, and in the final rule CMS opted to forgo the proposed reimbursement cuts.


Preparing a Biopharmaceutical Manufacturer to Launch a Drug into Federal Healthcare Programs

Case Study – Preparing a Biopharmaceutical Manufacturer to Launch a Drug into Federal Healthcare Programs

To ensure provision of a comprehensive approach to launch, we conducted a landscape assessment of federal healthcare program coding, coverage, and reimbursement parameters of relevance to the product. We provided the client with a detailed education on Medicare, Medicaid, 340B and VA/DoD programs, including recommendations of the actions the client should take to become a participant in those programs and a timeline of key deadlines before and after the launch of the product.

Issue:

A small, investor-funded biopharmaceutical company with no commercial products was preparing for the launch of a pipeline drug in two years’ time.

Outcome:

The client gained an understanding of the potential coverage and reimbursement challenges and opportunities for the product and mechanisms for advocating for its priorities in addressing a public health need in these programs.

Client Testimonials


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