Medicare Reimbursement: Translating Theory Into Practice

Medicare Congress Pre-Conference Symposium

Medicare Reimbursement: Translating Theory into Practice

Workshop Agenda Sunday, October 15, 2006 1:00 p.m. – 4:00 p.m.

Objectives:

 Understand the importance and business impact of the reimbursement process (coverage, coding and payment)  Recognize how coverage decisions can influence market success  Understand the significance of various coding systems and importance of coding for new products  Develop an understanding of payment mechanisms and the challenges for products used across different sites of service  Explore the interaction between Medicare Part B and Part D  Use case studies and active discussion to enhance knowledge

Welcoming Remarks and Introductions...... 1:00 – 1:15 p.m. Perry Bridger, Avalere Health

Coverage Challenge: The Natrecor® (nesiritide) Case Study...... 1:15 – 1:45 p.m. Perry Bridger, Avalere Health

This session will present an overview of the coverage process and use Medicare’s national coverage determination (NCD) review of Natrecor® (nesiritide) as a case study to illustrate key points. We will also discuss some of the recent trends in coverage, including the use of evidence-based medicine principles to set coverage policy.

The Role of Appropriate Coding...... 1:45 – 2:30 p.m. Chris Mancill, Amgen, Inc.

This session focuses on the important role of coding in obtaining coverage and payment for new product launches. Relevant case studies from Amgen's experience will be reviewed.

Break...... 2:30– 2:45 p.m.

©Avalere Health LLC Payment Challenges Across Sites of Service...... 2:45 – 3:30 p.m. A Case Study of Kinetra® Deep Brain Stimulation for Parkinson's Disease Jeff Farkas, Medtronic, Inc.

This session will address the challenges of gaining reimbursement for medical technologies that span multiple sites of service and Medicare payment systems. It will cover the payment mechanisms available in Medicare to recognize the costs of new medical technologies, and provide practical suggestions for manufacturers and others confronting similar challenges.

The Changing Reimbursement System: Interaction Between Medicare Part B and Medicare Part D...... 3:30 – 4:00 p.m. Lauren Barnes, Avalere Health

Many complexities exist when navigating the Medicare Part B and Part D reimbursement landscape. This session will discuss when products meet the coverage criteria to be covered in one of the benefits, or both of them.