FAQs

Medical Directors are critical decision makers for medical procedures. They can deny coverage, limit coverage, limit site of service, create utilization screens and erect other brakes to your technology reaching patients. If you are concerned about how insurance plans will react or are reacting to your product or service, Payer Insight’s services are invaluable. Satisfying the needs of health plans is critical to achieve success. The source of payer resistance is hard to determine. Like the crying baby, it can be frustrating to determine why the payer is not onboard. We developed Payer Insights to gain an understanding of payers objections. This helps companies target their limited resources in the way that will develop the most results.

Since Covid began, panels have been held over the internet. While effective, we believe that the in person format is still valuable and “worth the trip”. We anticipate offering both options when it is safe to do so.

Ideally prior to the start of FDA clinical trials and also soon after any OUS commercial activity begins. Also if the product is being marketed but coverage is limited.

Usually 5 – 6

When in person, Washington DC is the most common location. But panels have been held in San Francisco and Chicago. Some panels are virtual during the pandemic.

Panels can last anywhere from 1 – 6 hours, but the recommended time is in the 3 – 4 hour range. In our experience, panels over 4 hours can create participant fatigue.

Members are selected because they are interested in new products that might eventually help their own organizations. Our pool of potential panel members are all active medical directors currently or recently employed in positions of influence within payer organizations. Since many have worked for more than one payer, they have a very wide and relevant perspective. We also strive to identify and include medical directors who are familiar with a specific disease state or specialty as a part of the panel. Format includes both a client presentation as well as a moderated session of Q&A.

Focus  Panels allow senior managers as well as possible skeptics to observe first hand. They also allow for real-time interactive discussion, which provides the opportunity to course correct or give supplemental detail if needed during the presentation.

The FDA requires a technology to be “safe and effective”. Payers look at things from a different perspective than the FDA. Specifically, is the technology “effective, safe and durable”;  and they are traditionally skeptical of new technologies that are not yet proven in real world use.  The most common coverage decision is non-coverage because the device is considered “experimental” or “investigational” and requires further evidence/research.  They apply these terms even post FDA success.