Skip to Main Content

Predictive Payer Coverage Solutions: Enabling Clients to Hit the Ground Running

July 2, 2021


By Rayellen Kishbach

Policy Reporter’s goal is to improve patient access to life-changing therapeutics, devices, and diagnostics through a proven, vetted, and collaborative process of payer intelligence and advocacy. Our clients have access to real-time policy, coverage, and prior authorization data that’s proven to enhance market access strategies.

A starting point for our clients (especially when FDA approval is pending) is our Predictive Payer Coverage Solution, offered through our suite of market access tools.

One of our clients—a major U.S. medical device manufacturer in the surgical services space—has forth-coming FDA approval and new Category III CPT codes expected, and needed to intelligently predict timing, while also keeping payer advocacy top of mind.

Although our client has a team of market access and health economics experts, they knew they would benefit from leveraging Policy Reporter’s rich data and medical device expertise to drive their strategy. Through our Predictive Payer Coverage Solution, we delivered a comprehensive analysis, report, and executive summary within one month.

The solution provided directional data and analysis for the release of target products based on predictive models using historical data, and concrete intelligence to drive market access strategy.

We delivered a full landscape of therapeutic analogs and mapped the level of clinical evidence required for positive coverage. This included:

  • Review of current policies with coverage and non-coverage of analog therapeutics.
  • Assessment of prior authorization criteria that might complicate or simplify access to care.
  • Analysis of analog products over time to understand payer behavior in the target clinical area.
  • Modeling adoption of Category III CPT® codes.
  • Outline of key technology assessment organizations that influence market access, and guidance for specialty society support.
  • Recommended payer target list based on the impact of existing non-coverage policy, the lag time in initial coverage from FDA approval, number of clinical studies, and rating of the quality of evidence.

For more information on our Predictive Payer Coverage Solution and how it helped this client improve its market access strategy, view this case study, or connect with a member of our team:

Rayellen Kishbach
Director of Business Development, Policy Reporter

Policy Reporter, acquired by TrialCard in 2019, provides innovative healthcare software solutions to track payer policies in near real-time and enhances market access for the therapies patients need most. The company’s patented software-driven solutions include a suite of billing and reimbursement tools for providers and laboratories, market intelligence tools for payers, and a suite of market access solutions for life science companies. Its clients include some of the world’s largest pharmaceutical and healthcare companies.

Maximize value across the product and patient journeys. Find out how.