Practical Advice for Medical Devices Firms | Page 11

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Private carrier payment
When a company is trying to obtain approval from managed care
organizations, data must be submitted that includes peer-reviewed
literature, assessments by specialty organizations, and endorsements
from key opinion leaders. Unlike the Center for Medicare and Medicaid
Services, private payers often consider cost of the device in their
decision-making analysis.
One of the most developed entities in the private payer evaluation
process is the Blue Cross Blue Shield Technology Evaluation Center that
uses the following five criteria for reimbursement approval:
1. The technology must have received final approval from the
appropriate governmental bodies
2. Scientific evidence must permit conclusions concerning the
technologies affect on health outcomes
3. The technology must improve the net health outcome
4. The technology must be as beneficial as any established
alternatives
5. Improvement must be obtainable outside the investigational
setting

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