U.S. Department of Health and Human ServicesHHS National Institutes of HealthNIH National Center for Advancing Translational SciencesNCATS
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Support Access To A New Therapy

Tips for Success

  • Talk to other patient groups at conferences and other events to share strategies that have been successful and those that have not been. 
  • Watch for conferences focused on achieving reimbursement through public and private insurance providers for newly marketed therapies.
  • If your newly marketed therapy uses a cutting edge technology, such as gene transfer, consider collaborating with other patient groups who also have a newly marketed therapy using the same technology. 
  • Request members of your disease community share with you their own successes with specific insurance providers. 
    • You may be able to leverage one person’s success into a more global acceptance by the specific insurance provider. 
    • You can share the strategy used to gain approval with other members of your community who have the same medical insurance provider.
    • Determine whether there are any common strategies that might be applicable to other insurance providers.
    • Develop a toolkit of possible strategies that individual patients/families may use to gain reimbursement approval.
  • Involve members of your Scientific/Medical Advisory Board as well as the specialists who treat your disease communities to advocate for insurance provider reimbursement.
    • Many professional societies have advocacy committees. You, members of your Scientific/Medical Advisory Board, or specialists in your clinical care network may consider reaching out to these committees to determine if a collaboration can be formed.