Identifying Opportunities for Client to Drive Managed Medicaid for Ophthalmology Product

ThinkGen’s client had a diabetic eye disease product with a market share in the Managed Medicaid channel that was approximately half that of their Medicare or commercial channels. Feedback from the client’s account team indicated that reimbursement confidence was low among physicians and office staff for Managed Medicaid plans.

The client hypothesized that physicians have “been burned” by Managed Medicaid plan reimbursement in the past, so are now prescribing generic instead of “Product X” due to practice financial concerns over denied reimbursements, reimbursements less than product cost, and long timelines for reimbursement. Because the product is buy and bill, the offices are paying for the product up front; so if they aren’t reimbursed for months, they are perpetually losing money.

ThinkGen was asked to:

• Assess the magnitude of reimbursement confidence amongs ophthalmologists and their staff for their Managed Medicaid patients

• Identify strategies to drive reimbursement confidence for Medicaid patients in lieu of messaging, including manufacturer-supplied programs or support