Top 3 Mistakes to Dodge When Navigating Positive Healthcare Payor Coverage

a healthcare worker measuring a patient s blood pressure using a sphygmomanometer

Securing favorable coverage from healthcare payors for your product demands a strategic approach. While working within the medical policy field, I have seen my share of products not covered by payors even though the manufacturer felt confident the evidence supported it.

Here are three pitfalls to evade:

Underestimating Value Demonstration

Convincing healthcare payors goes beyond highlighting product features. Neglecting to showcase how YOUR product significantly improves patient outcomes, reduces costs, or enhances overall healthcare quality can hinder success. Construct a robust case demonstrating the tangible value your product brings to the table.

Focusing on how your product is better than a competitor’s does NOT guarantee positive coverage by health plans and hospital systems. Instead, you can come across like a used car salesperson.

Disregarding Data-Driven Insights

Relying solely on anecdotes or incomplete data won’t cut it. Payors seek evidence-based solutions. Avoid the mistake of overlooking comprehensive data from well-designed clinical trials, real-world studies, and health economic analyses. Concrete data is a persuasive tool in negotiating coverage terms.

In another post, I will cover this point in greater detail–it is THAT important to securing positive payor coverage.

Overlooking Patient Access

While engaging with payors is crucial, don’t forget about the patients. Failing to address affordability, convenience, and availability can undermine coverage efforts. Develop strategies to ensure your product is accessible and beneficial for patients, enhancing its appeal to payors.

Remember, the path to positive payor coverage involves a synergy of value, evidence, and patient-centricity. Focus on those rather than delving into a diatribe against a competitor or than throwing every piece of data at the reviewer.

By steering clear of these missteps, your product can garner the attention and endorsement it deserves from healthcare payors. The ultimate goal is to provide the patient with appropriate, evidence-based care. 💼

If you need help with getting payor coverage for your product, just email me at

Day-Storms, LLC provides full medical writing and consultation services. For more information, check out our Services page.

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