Strategic Pricing & Reimbursement

As healthcare pricing pressures grow worldwide, excellence in strategic pricing has become essential to achieving long-term organizational results.

Getting pricing “right” has immense implications. For shareholders, it can mean enhanced current returns and a more secure long-term ability to re-invest in research. For patients, it can mean better access to today’s valuable medications and more of these in the future. For payors, it can mean lower total healthcare costs.

Infusion has provided guidance on brands with revenues in excess of $12 billion, including some of the industry’s most unique and competitively challenging products. And as strategists, we have been on the forefront of anticipating and preparing clients to navigate sweeping structural changes in pricing and reimbursement.

The Infusion Difference

Infusion’s pricing practice is a distinct resource in several ways:

  • Strategy-Driven - We consider strategic pricing to be a central component of a fully integrated development and marketing strategy, not an independent element to be designed in isolation and grafted on. Unlike many pricing specialists, we’ve also had responsibility for managing brands.
  • True Pricing Expertise – Healthcare pricing is a complex, inter-connected and ever-shifting matter that operates under intense public and private market scrutiny. Missteps can be costly, irrevocable and embarrassing. Infusion professionals bring deep pricing expertise and long experience to this mission-critical task.
  • Outlier Product Experience – Our clients bring us some very unusual products and pricing challenges. We enjoy the challenge and provide them with strategies that work.

Strategic Pricing & Reimbursement Services

Strategic pricing comprises a series of decisions taken over the life of a product that seek to:

  • Create, optimize and evidence product value across all indications
  • Participate in the value created
  • Maintain and enhance value over the life of the product

Accordingly, Infusion offers a range of services appropriate to products across their life cycle.

These include:

  • New Product Pricing & Access – A complete solution for optimizing emerging product value and maximizing access. Elements include market segmentation, value assessment, elasticity modeling, reimbursement and access planning, and approaches for evidencing value.
  • Multi-Indication Drug Pricing – Value-depleting pricing incompatibilities often arise when seeking to unlock greater asset value through multiple indications. We can work with you from early development forward to engineer optimal value across a range of indications.
  • Orphan Drug Pricing – Low prevalence diseases represent some of the most difficult pricing situations. Infusion has supported senior executives in the pricing decisions for a range of niche and ultra-niche orphan drugs and has developed a rigorous approach for bringing clarity to these decisions.
  • Advanced Competitive Pricing Strategy - Offensive and defensive strategies to break through stagnant markets, counter competitive attacks or arrest unproductive spirals. These require a crystal-clear understanding of the situation and potential repercussions. Competitive war gaming is a key component of this offering.
  • Market Access Strategy – Comprehensive approach to maximizing returns from public and private payors. Focus includes managed care, Medicare Parts A, B and D, and Medicaid as well as GPO/IDNs, specialty pharmacy and hospital accounts.
  • Reimbursement Strategy – Expert capabilities in reimbursement planning and execution with a focus on compressing time to effective reimbursement and optimizing peak reimbursement levels. Focus includes private payors, Medicaid and Medicare Parts A and B.

Selected Infusion Strategic Pricing & Reimbursement Engagements

  • Develop a pricing optimization strategy for major hospital brand with five different indications, each at different stages of development and each with different dosages and potential value points.
  • Plan the reimbursement strategy for a high-cost hospital drug for which no pass-through reimbursement had been obtained.
  • Develop the Medicare Part D roll-out strategy (corporate and all key brands) for Top 10 company.
  • Find a way to halt and reverse accelerating pricing erosion in competitive physician-administered product market.
  • Validate a client’s proposed pricing strategy for an implantable drug participating in a high-visibility product area.
  • Develop the pricing strategy for an ultra-niche orphan drug for a previously untreatable progressive disease.