Preparing Before the Storm: The Reimbursement Policy Disaster

By Laurel Todd, Director, BIO

During Tuesday's panel, we had the opportunity to lay the foundation of Medicare reimbursement policy, and discuss current trends and how health reform my impact reimbursement for biotechnology therapies in the future.   Jayson Slotnik, an attorney with Hogan and Hartson in Washington, DC, opened the panel with an overview of the coding, coverage and payment basics of Medicare policy.  He provided an excellent primer on Medicare 101.  Building upon the currrent policies that Jayson outlined, I presented on trends in Medicare payment policy. Andy Swire, of Amgen's Washington DC office, then discussed the elements of a successful Federal engagement strategy, emphasizing the need to focus on building relationships, and not taking a transactional approach to interactions.  Finally, Sohini Gupta, with United Healthcare's DC office, provided insight into the payor perspectives on reimbursement and health reform.  Sohini's bottom line message resonated with all members of the panel:  In the context of health reform, all stakeholders are being asked to 'do more, do it better, and spend less'.  Simple, right? Lynn Taylor, of EMD Serono's Washington DC office moderated the panel and lead the audience in a lively discussion with the panelists.  Questions ranged from the role of political lobbying to the patient advocate's role in influencing reimbursement policy, to specifics about how early small biotech companies should begin a federal engagement strategy to technical advice on how to attain coding, coverage and reimbursement for their novel therapies.  Health reform and its various components were also hotly debated including why Medicare policies are central to the discussion and how comparative effectiveness research could impact payment for breakthrough therapies.  Panelists and audience alike enjoyed the conversation and found the opportunity thoughtful and practical.