Lining up support for a New Technology Add-on Payment in a rare-disease treatment
Case Study:
Securing NTAP Approval for a Rare Disease Treatment
This case study highlights how Magnolia Market Access helped a biopharma company secure a New Technology Add-On Payment (NTAP) from CMS for a rare disease treatment, enhancing reimbursement and supporting hospital adoption.
Key Highlights:
- Challenge: Assess and secure NTAP approval to offset financial losses hospitals might incur without the additional payment for the high-cost treatment.
- Approach:
- Conducted a financial assessment to determine NTAP eligibility based on CMS criteria, including novelty, cost, and substantial clinical improvement.
- Submitted an NTAP application, providing robust clinical and financial justifications.
- Presented findings to CMS at the New Technology Town Hall meeting and applied for a unique ICD-10-PCS code to facilitate proper billing.
- Outcome:
- NTAP approval resulted in an average additional reimbursement of $15,000 per case.
- The client received a unique ICD-10-PCS code and reimbursement guides to ensure proper billing and coding for providers.
Download the case study to discover how strategic reimbursement planning can optimize access and adoption for innovative treatments.
