One of the key elements for a successful market entry and reimbursement strategy is not only to demonstrate the scientific evidence but also to communicate the (added) value of a device or technology to providers (e.g., hospitals, doctors) and payer authorities.
Our team is highly experienced in the development of market access and reimbursement supporting materials and tools such as:
- Coding and reimbursement guides to support your field sales and marketing staff
- Hands-on reimbursement assistance and advice for clinics and doctors
- Templates such as those for case-by-case reimbursement applications
- Presentations and articles for various audiences
For many innovative methods, a quick market access in the German outpatient segment will depend on a positive reimbursement environment in the privately insured sector, i.e. whether or not the private insurers and will cover the cost of the procedure or if the method remains limited to the self-pay market in Germany. As a part of a short to medium-term outpatient market access strategy, companies may initially target the self-pay as well as the privately insured (PKV) and Beihilfe patients (roughly 11% of the German population).
You may support interested centers / doctors by providing a Private Payer Package (PPP). Such a dossier has proven to be a valuable tool for supporting the interested doctors in their efforts to obtain positive reimbursement decisions by the private health insurers and potentially the SHI funds. Our PPP typically includes:
- A GOÄ (reimbursement catalogue for privately insured) coding and reimbursement guide with suggested analogue GOÄ codes that may be applicable to your technology and hints regarding case-by-case reimbursement applications for self-payers and privately insured patients according to payer requirements;
- Sample letters to insurers with patient-tailored arguments for reimbursement applications regarding “medical need” and “individual patient benefit” including tailored documents to be attached to the application.
Healthcare organization and financing in the German-speaking countries is focusing more and more on selective contracting rather than only on standard regulations and contracts (such as the current DRGs systems for hospital care). Forms of direct contracts between payers (sickness funds) and providers (doctors or hospitals) in Germany include, for instance, Integrated Care concepts. It may be worthwhile developing concepts and contracts in this area, at least as an interim option and/or partial solution leading to reimbursement with respect to novel healthcare technologies,