NATIONAL REIMBURSEMENT STRATEGY

• Reimbursement environment scan at national level

  • Systematic literature review covering clinical, health economics and  real-life evidence

  • Country-specific patient pathway and therapeutic strategy based on national recommendations

  • Healthcare system and country-specific reimbursement pathways description

  • Competitive landscape

  • Coding and reimbursement analysis: DRG-based payment, add-on DRG top up payment, early access scheme, global budget, fee-for-services... 

    • DRG tariff estimation based on consistent clinical scenarios and hands-on knowledge of local tariff algorithms

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• Strategic reimbursement analysis at national level

  • Regulatory analysis associated with the reimbursement analysis, if needed

  • Evidence gap analysis with recommendations for evidence generation to best meet country-specific clinical and HEOR requirements

  • Identification of unmet / not sufficiently met needs and associated target population for the reimbursement claim

  • Determination of the level of adoption by the medical community

  • Determination of optimal country-specific reimbursement pathway with eligibility requirements if any (e.g restriction of indication and/or of user centers, evidence requirements...)

  • Development of payer value proposition and value story

  • Identification of country-specific drivers and barriers for adoption and reimbursement : acceptance of treatment & willingness to pay based on commissioning policy and relevant HTA

  • Drafting of the contact plan : mapping of relevant payers, HTA bodies, KOLs, medical societies, insurance bodies… specifying the rules of engagement (early meeting, conference call, physical meeting…)

• Strategic recommendation at national level

  • Recommended market access plan including detailed process description, contact plan, timeline and budget estimation