Speakers at Inaugural EEC Event Encourage Life Sciences Companies to Establish Early Relationship with CMS
written by David A. Broadwin
"What Early Stage Life Sciences Companies Need to Know About Medicare Coverage and Reimbursement" was the focus of the inaugural event held this morning at the Emerging Enterprise Center. The event was co-sponsored by the National Venture Capital Association, and featured Sean Tunis, MD, MSc, Director, Center for Medical Technology Policy and Brian Quinn, MD, MBA, Medical Director, National Heritage Insurance Company (NHIC). Tom Grissom, Senior Health Policy Specialist at Foley Hoag and former director of the CMS Center for Medicare Management, was also a featured speaker.
Dr. Tunis outlined recent trends in reimbursement, including: (1) Cost trends are pushing payers and policy makers to focus on value and efficiency; (2) Evidence-based Medicine is a growing focus in coverage; (3) Cost and cost-effectiveness are considered; (4) Clinical and economic results increasingly influence coding and payment policy; (5) Coverage with evidence development is a new tool for CMS, possibly private payers; and (6) Public and private evaluations of clinical and economic effectiveness are increasing. Dr. Quinn, who heads California’s Medicare Part B efforts, gave attendees an insightful first-hand look at the Medicare system and some of its innerworkings, discussed the definition of “reasonable and necessary,” and talked about new challenges to Medicare and to life sciences companies. Tom Grissom lent inside knowledge of CMS based on his personal experiences to attendees, underscoring the major theme of the day: it is critical for life sciences companies to establish an early relationship with CMS, even during FDA trials, to ensure collaboration and mutual accomplishment.