In a regulated system such as the statutory health insurance, it is not only evidence and benefits that determine market success, but also reimbursement mechanisms, pricing logic and regional care structures.
Patient Access & Reimbursement
Typical questions from practice
Complex framework conditions, translated into concrete, implementable measures.
We combine social insurance law expertise with application-oriented health economics and translate complex framework conditions into concrete, implementable measures. From early benefit assessment to price negotiations and regional implementation in healthcare.
Market access does not always end with marketing authorisation or an agreed reimbursement price. Hurdles at regional, decentralised level – through the KV and the MD – often prevent market penetration. Market access is therefore not a single step but a continuous process – across different stakeholders and regulatory processes.
Evaluation of KV systems, medicines audit agreements and efficiency mechanisms and their influence on market access.
Evaluation of reimbursement options (e.g. EBM, DRG, IGeL), preparation of communication with authorities such as the G-BA, health insurance funds and professional associations.
Conception of integrated market access strategies for Germany, Austria and Switzerland, including support for procedures (KLV/BAG, LKF).
Identification of relevant players among health insurance funds, KVs and service providers and development of regionally differentiated market access strategies.
Further development of existing reimbursement models (e.g. NUB, supplementary fees, DRG) as well as support in price negotiations at federal level with renowned cooperation partners and in discount and price adjustment processes.
Conception, negotiation and implementation of selective contract models (e.g. §140a SGB V) in cooperation with health insurance funds and service providers.
Support in the evaluation of new G-BA requirements or health policy changes and their impact on reimbursement and utilisation. Statements on IQWiG reports, support for expert discussions and information events.
Translation of reimbursement logic into concrete lines of argument, development of practical business cases and training of sales and market access teams.
Development of relationship management with relevant stakeholders such as health insurance funds, KVs and associations. Preparation of documents for communication and interaction with authorities (MD, KV, medical associations, pharmacists' associations and others).
No off-the-shelf solutions, but measures that truly hold up in everyday SHI practice.
We do not provide standard solutions, but work with you to develop pragmatic measures that are tailored to your challenges and actually work in everyday SHI practice.
Combination of social insurance law expertise, health economic methodology and operational experience with health insurance funds and other decision-makers.
Clear methodology, comprehensible results and professional project management with high adherence to deadlines.
Faster market access, reliable decisions and stable revenues.
Clear strategies and operational support enable efficient navigation through regulatory and regional hurdles.
With data-based analyses, we create transparency in the complexity of regional health insurance regulations, reimbursement mechanisms and care specifications and provide a sound basis for strategic decisions.
Well-founded lines of argument and concrete negotiating levers ensure sustainable price levels, even under increasing cost pressure.
Established network with health insurance companies, KVs, associations and other decision-makers in the healthcare system.
