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Reimbursement Consultation


Getting market approval is one milestone for a new product. Adoption requires getting that new product paid for – in any number of ways.  In the US, coverage or reimbursement by a public or private healthcare plan is the most common approach for new therapies, though direct-to-consumer sales also have a role. Reimbursement consults are an opportunity for innovators to explore critical topics regarding who will pay for their product, and how. An incomplete list of topics regularly discussed during these consults includes understanding the differences between HCPCS and CPT codes, formulary structure, payer approaches to new technologies, national versus local coverage models, coding and payment amounts for similar technologies, and bundled versus individual charges.

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To complement our consult program, we developed a suite of plain-language resources describing common reimbursement questions and activities. Grouped by product type, we hope these documents, case studies, and short videos are helpful to your product-development work.

reimbursement devices
Medical Devices
Information and case studies describing reimbursement for medical devices and digital health products
reimbursement drugs
Information and case studies describing reimbursement for drugs.
reimbursement diagnostics
Reimbursement resources for FDA-regulated diagnostics – including in vitro diagnostics, laboratory developed tests, and companion diagnostics.