Harvard i-lab | Understanding Reimbursement for Health and Life Sciences Startups | Summary and Q&A

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April 28, 2015
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Harvard Innovation Labs
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Harvard i-lab | Understanding Reimbursement for Health and Life Sciences Startups

TL;DR

This content discusses the importance of considering reimbursement strategies when developing life sciences products, including understanding coverage, coding, and pricing.

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Key Insights

  • 🖐️ Reimbursement strategies play a vital role in the development and commercialization of life sciences products.
  • ♿ Understanding coverage, coding, and payment methodologies is essential for determining market access and pricing.
  • ⚾ Value propositions and evidence-based decision-making are crucial for demonstrating the impact of a product on patient outcomes.
  • 🧔 Hospitals and providers bear financial risks and are often the purchasers of life sciences products, while payers reimburse for procedures.

Transcript

so it's a pleasure to be here thank you for having me and i look forward to meeting some of you next week as well during office hours just to give you a little bit of background i have been in the life sciences industry for about 34 years i started when i was five and i actually started in the in the biotech and pharmaceutical world um at that time... Read More

Questions & Answers

Q: How did the traditional reimbursement system evolve to accommodate new technologies like biotech and pharmaceutical products?

Traditionally, insurance systems were designed for inpatient hospital stays, so there was no method to reimburse biotech or chemotherapy products administered in a doctor's office. This led to the need for grassroots efforts to create reimbursement methods for these new technologies.

Q: How do investors, particularly in the life sciences industry, view and ask about reimbursement?

Investors often ask about reimbursement and coding as they want to ensure that the product will be reimbursed by payers. It is important to understand the right questions to ask to address their concerns and demonstrate the value proposition of the product.

Q: Can the regulatory approval of a product impact reimbursement decisions by payers?

Regulatory approval does not guarantee reimbursement decisions. Payers assess the clinical evidence and value proposition of a product before making coverage decisions. However, products that have undergone more rigorous clinical trials may have more evidence to support coverage and reimbursement decisions.

Q: How does coverage, coding, and payment work together in the reimbursement process?

Coverage determines access to a product, coding provides a language to translate diagnoses and procedures into payment, and payment addresses the remuneration for services rendered. These elements must work together to ensure the successful commercialization of a product.

Summary & Key Takeaways

  • The speaker has 34 years of experience in the life sciences industry and shares how reimbursement strategies have evolved over time.

  • Reimbursement is crucial for life sciences products as it determines access to healthcare and the ability for providers to purchase and use the technology.

  • Understanding coverage, coding, and payment methodologies is essential for developing a successful reimbursement strategy.

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