DRG’s nationwide claims and remittance data for the U.S. shows a wide range of reimbursements for Prevnar13--from $140-$354.98 for .5 ML-- for providers who submitted more than 50 claims (ASP = $173.151). Point of Service (POS) plans reimbursed at the highest rate for Prevnar13, and of such plans, Harvard Pilgrim Health Care reimbursed at the highest rate. For comparison, claims for Pneumovax were reimbursed at a range of $58.80-$80.87 for .5 ML (ASP = $82.51). Providence Health Plan reimbursed at the highest rate among POS plans for Pneumovax.
Reimbursements for Prevnar13 and Pneumovax varied considerably nationwide; claims for Prevnar13 were reimbursed at the lowest rate on average in the Western states, while claims for Pneumovax were reimbursed at the lowest rate in the Midwest.
These dynamics, and more, are available in DRG’s Specialty Product Reimbursement Compass (“SPARC,”) a new subscription service that provides unblinded data and insights on specialty product reimbursement dynamics, with a focus on payers, providers, and patients. SPARC provides ongoing monitoring of “buy and bill” claims and remittance data updated weekly, monthly, and quarterly.
SPARC Informs Market Access Tactics
- Gives biopharma real world data to influence payer contracting strategy
- Highlights where products are advantaged/disadvantaged by U.S. payers
SPARC Supports Physician Targeting
- Highlights which physicians are getting reimbursed for which products at what rate (and by whom)
- Allows biopharma to identify and target physicians who are actively and under-utilizing your product
- Provides insight into product profitability to influence provider contracting
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