Case Study 6 – Payer Uptake of New Indications

Identifying the 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.

The Role of DK Pierce & Associates
DK Pierce monitored Medicare, Medicaid and select commercial payer activities by following coverage decisions, proposed policy drafts, provider communications, and product review meetings.

Demonstrated Outcomes
DK Pierce identified draft policies that inappropriately excluded certain RA patient populations from receiving the new drug. We also alerted our client to upcoming Medicaid meetings where their drug would be reviewed for coverage positioning and payment level. As a result of our activities, our client's drug had unrestricted access at both Medicare and Medicaid.