Patient Access: Consider taking active role

Q. What is market access and what is the value to me? 

A. Pharma and biotech have long recognized the value of investing in market access to enable consumer access to therapies. As of recent, HME manufacturers have begun to invest in internal teams to address coverage and reimbursement restrictions with an overall goal of improving access for end-users. The work may take the form of advocacy on the federal level with CMS or with individual state Medicaid programs to improve coverage or reimbursement for product categories or individual HCPCS codes.  

Recent achievements in the ostomy product category include expanded access to extended wear products by 11 state Medicaid programs. In the intermittent catheter space, advocacy work led to improved reimbursement for catheters by New York Medicaid, supporting clinician and end user choice for the catheter that meets their unique needs.  

Market access work is varied but relies on a core blueprint that involves listening to and elevating the perspective of clinicians, end users and DMEs, and translating this information to payers. Successes are typically brand agnostic and benefit all. As an industry stakeholder, you may consider partnering with a manufacturer market access team by:  

Elevating the voice of end-users by sharing when product access is limited because of coverage or reimbursement policies; 

Supporting ongoing efforts by participating in information interviews, letter-writing campaigns or attending payer meetings; and joining AAHomecare and your state HME/DME association. 

Regardless of how active a role you take, realize that manufacturer market access teams are here to support you as an industry stakeholder. If there is an issue impacting end user access and your business, it is likely impacting others. Consider flagging the issue to a market access team and/or your state HME/DME association. 

Kathryn Vaughn is director of Market Access for Coloplast. Reach her at uskva@coloplast.com.