Case study

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Case study #1

Challenge

A mid-sized pharmaceutical client was in the process of developing a pediatric indication product for a rare disease. Patient data indicated that the targeted therapeutic would see high utilization within both Medicaid and the supplemental Children’s Health program. Catalyst was engaged to develop a public payor strategy to secure coverage through state Medicaid pharmacy and therapeutics (P&T) committees while managing the statutory and supplemental rebate requirements states were likely to impose.

Strategy

  • Created a roadmap for coverage and payment concentrated on states with identifiable patients who could benefit from the product.
  • Leveraged patient groups and key physician opinion leaders to advocate for expedited coverage.
  • Collaborated with the client’s product team to encourage correct product pricing, capturing the value of the innovation without adversely impacting state coverage decisions.

Impact

  • Patient utilization in targeted states met expectations.
  • Uptake of the drug has been slow in states that were not included in the roadmap.

Case study #2

Challenge

A small start-up device manufacturer received breakthrough designation from the FDA. Having never launched a product in the US before, the company asked Catalyst to develop a coverage and payor strategy designed to drive uptake and utilization.

Strategy

  • Create a reimbursement strategy identifying opportunities for additional funding, including leveraging the New Technology Add-on Payment (NTAP) methodology.

Impact

  • The company is leveraging the coverage and reimbursement roadmap to secure Series A financing, aiming to receive FDA approval.
  • If approved, the approach would incentivize state Medicaid agencies to adopt the use of the device and lower overall health costs and create better health outcomes for an at-risk population.

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