Milken: Women’s Health Coverage Issues
A recent Milken Institute report examines how insurance coverage and reimbursement challenges limit access to women’s health innovations. The report identifies nine key barriers, including undervaluation of women’s health, fragmented payer pathways, and limited billing mechanisms.
Key Barriers Identified
The Milken Institute report, developed by the Women’s Health Network’s Coverage and Reimbursement Working Group, lists nine obstacles that hinder coverage and reimbursement for women’s health products and services. These barriers are:
- Undervaluation of women’s health
- Fragmented payer pathways
- Limited billing and reimbursement mechanisms
- Gaps in sex-specific evidence
- Reimbursement uncertainty
- Administrative complexity
- Prior authorization requirements
- Limited clinician adoption
- (The ninth barrier is implied by the list, but the report does not specify a separate title for it.)
Each barrier creates a barrier to the commercialization of new care models and technologies, making it difficult for patients to access innovative solutions.
Recommended Go-to-Market Strategies
To overcome these challenges, the report proposes three primary strategies:
1. Self-pay models 2. Commercial payer coverage 3. Public programs such as Medicare and Medicaid
The authors argue that a combination of these approaches can help bring new products to market while ensuring that patients can afford them. The report also stresses the importance of early engagement with payers and clinicians. By aligning evidence generation with coverage requirements, innovators can more effectively integrate new solutions into clinical workflows.
Implications for Innovation and Access
The report notes that as more women’s health companies introduce new care models and products, coverage and reimbursement remain a critical hurdle. Without adequate payment pathways, even the most promising innovations struggle to reach the broader patient population.
The authors call for a shift in how evidence is collected and presented. By working closely with payers from the outset, companies can tailor their data to meet coverage criteria, reducing uncertainty and administrative burden.
The report also highlights the need for better integration of new solutions into existing clinical practices. This integration can be facilitated by clinician education and the use of technology platforms that streamline care coordination.
Call to Action
The Milken Institute report urges stakeholders to:
- Engage payers early in the development process
- Align evidence generation with coverage requirements
- Integrate new solutions into clinical workflows
These steps can help reduce the nine identified barriers and improve commercialization outcomes.
The report concludes by emphasizing the need for earlier payer and clinician engagement to better align evidence generation with coverage requirements and integrate new solutions into clinical workflows.
