Reimbursement Landscape Analysis

Maximizing prices, contracting, and securing reimbursement status are important factors for health care companies seeking to ensure that they achieve a high return on investment. This return must be viable under volatile conditions such as regulatory uncertainty, stagnant R&D, and cost-containment efforts of health care payers.

MME provides detailed analysis of the key issues and of the market environment which together make up the pricing and reimbursement evaluation landscape. This information gives customers a detailed understanding of the opportunities to maximize profit through value instead of simply price. Your company will have not only an optimized understanding of a product’s current potential but also a way to extend and enhance future returns.

MME has extensive experience in portfolio evaluation and life-cycle planning with major customer segments, including:

  • Health maintenance organizations (HMOs)
  • Pharmacy benefit managers (PBMs)
  • Hospital, health system, and group purchasing organizations (GPOs)
  • Oncology clinics
  • Specialty pharmacy providers (SPPs)
  • Federal and state government organizations

The following are examples of our work in this area:

  • Analysis of HMO and PBM reimbursement practices and their evolving impact on prescribing
  • Assessment and understanding of plan design barriers and how to address them
  • Development and support of contract design and implementation
  • Pull-through program development and support including performance metrics
  • Contract performance evaluation for both manufacturers and their customers
  • Mail-order and specialty pharmacy impact analysis
  • Therapeutic category opportunity assessment and competitive analysis
  • Qualitative market research with managed care decision makers in primary and specialty care markets