The Importance of Patient Access and Market Access Programs for Innovators in Wound Care

Introduction

The Symposium on Advanced Wound Care (SAWC) is a premier conference for the medical technology (MedTech) industry, bringing together industry leaders, researchers, and clinicians to discuss the latest innovations in wound care. For MedTech innovators attending the SAWC Fall 2023, one critical consideration is patient access and market access programs. These programs can play a crucial role in ensuring that innovative wound care treatments and products reach patients in need of critical care for their disease state. This white paper explores the importance of patient access and market access solutions and programs for MedTech innovators specializing in wound care.

Patient Access Programs

Patient access programs (PAPs) are designed to liberate innovative medical technologies for patients in need of crucial care for their disease state. Tailored specifically to the initiatives, goals, and nature of each individual innovation, PRIA Healthcare’s PAPs help MedTech, and life science innovators overcome common barriers in patient access solutions.  By advocating on behalf of patients, building utilization data, and ultimately achieving positive payer coverage decisions (achieving successful commercialization) for MedTech innovators, PRIA’s patient access professionals are poised to support the liberation of novel technologies, delivering improved patient outcomes for those in need of specialized wound care. For MedTech pioneers attending the SAWC, patient access programs can be a critical tool for ensuring that innovative wound care treatment reaches patients in need – faster.

PRIA Healthcare’s PAPs Capabilities:

Equipped with a proprietary, salesforce-powered, HIPAA–compliant, real-time, and cloud-based portal, PRIA Healthcare is able to execute the following to ensure that your novel therapy is accessible to those that need it most, driving the commercial adoption of innovations in wound care.

1. Benefits Verification: The process of confirming information such as coverage, copayments, deductibles, and coinsurance with a patient’s insurance company.
2. Prior Authorization: Approval from a health plan that may be required before a patient receives care in order for the service/procedure/technology to be covered by insurance payers.
3. Pre-Service Appeals: The request to change a denial of coverage for a planned health care service. The member’s rights in the member’s benefit plan govern this process. To submit a normal pre-service appeal request, PRIA Healthcare’s expert case management team follows the information in the pre-service denial letter and has established an 80% win rate (the highest in the industry) for appeals.
4. Post-Service Appeals: PRIA’s professional case management team advocates on behalf of patients who have undergone wound-care services that were denied by payers by providing verbal and written requests to overturn an adverse determination made by the payer for care or service already rendered.
5. External Reviews: A review of a plan’s decision to deny coverage for, or payment of a service by an independent third-party not related to the plan. If the payer denies an appeal, an external review can be requested, and PRIA’s experts are able to perform external reviews on behalf of patients, including ALJs (hearings performed by an Administrative Law Judge).

 

Market Access Programs

Market access programs (MAPs) are designed to help MedTech innovators navigate the complex healthcare market and achieve commercial success. For MedTech innovators attending the SAWC Fall 2023, market access programs are indispensable for ensuring that innovative wound care products reach the market and achieve commercial success.

1. Regulatory Compliance: Market access programs can help MedTech innovators navigate the complex regulatory environment by ensuring that their products comply with FDA regulations and other regulatory requirements. PRIA Healthcare has carefully curated industry-renowned expert partners in regulatory compliance, prepared to drive dynamic and successful compliance strategies to ensure adherence to compliance regulations set forth by CMS (The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
2. Pricing Strategy: Market access programs can help MedTech innovators develop a pricing strategy that is competitive and considers the reimbursement rates set by Medicare, Medicaid, and private health insurance companies. PRIA’s experts in CMS, coding, coverage, and payment reliably consult with partners to develop a tailor-fit pricing strategy, working in tandem with ordinances established with governing bodies.
3. Reimbursement Strategy: Market access programs can help MedTech innovators develop a reimbursement strategy that ensures that their products are adequately reimbursed by Medicare, Medicaid, and private health insurance companies. PRIA Healthcare’s Reimbursement, Value Generation, and Market Access (RVMA) accomplished and credentialled professionals are subject matter experts in developing reimbursement strategies appropriate for innovations in wound care.
4. Market Landscape Assessment: Market access programs can help MedTech innovators analyze the competitive landscape and identify opportunities to gain a competitive advantage in comparison to innovators that may forego this critical assessment. PRIA Healthcare’s RVMA experts are able to intricately provide analysis of the wound care innovation landscape and furthermore support successful reimbursement strategy.

 

Conclusion

Patient access and market access programs are critical for MedTech innovators attending the SAWC Fall 2023. These programs can help MedTech, Biotech, and life science innovators overcome barriers to access, navigate the complex healthcare market, and achieve commercial success. PRIA Healthcare’s Patient access programs can provide benefits verification, prior authorization, pre-and post-service appeals, as well as external reviews that can help patients access and use innovative advancements in wound care.

Market access programs can help MedTech innovators navigate the complex regulatory environment, develop pricing and reimbursement strategies, and gain a competitive advantage in the wound care innovation market.

By leveraging PRIA’s patient access and market access programs, MedTech innovators attending the SAWC Fall 2023 can ensure that their innovative wound care products reach patients who need them and achieve commercial success in the intricate labyrinth that is the US healthcare market.

PRIA Healthcare – Accelerating Healthcare Innovation

 Authored by: 

Marie Austin

Marketing Manager

PRIA Healthcare