Case Study: Payer Uptake of New Indications

Issue:
A DK Pierce client received FDA approval for an expanded indication of an existing drug (Rheumatoid Arthritis [RA]). Close monitoring would be required to determine payer uptake of the new indication.

Strategy:

• Monitored Medicare, Medicaid and select commercial payer activities by following coverage decisions, proposed policy drafts, provider communications, and product review meetings.

Outcome:

• Identified draft policies that inappropriately excluded certain RA patient populations from receiving the new drug.
• Alerted our client to upcoming Medicaid meetings where their drug would be reviewed for coverage positioning and payment level.
• Client's drug had unrestricted access at both Medicare and Medicaid.