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Medical Device Reimbursement in Canada.

Identification and application for inclusion in physicians' fee-for-service payment schedules, funding under hospitals' Quality Based Procedures and the Canadian DRG-like system (CMG+).

Reimbursement Landscape in Canada

The purpose of this step is to understand the current reimbursement environment in Canada, relevant for your medical device. To do so, we will:

  • Clarify the relevant type of coding systems (e.g., the Canadian Classification of Health Interventions, CCI), reimbursement catalogs (e.g., the Ontario Schedule of Benefits or the British Colombia Medical Services Plan), limitations and guidelines, relevant type of payment mechanisms (e.g., the Canadian DRG-like system (CMG+) or Quality Based Procedures (QBPs)) and payment rates, applicable for the specific device or to any comparable products.
  • Locate any specific reimbursement mechanisms that could be utilized by the device, as-is, or recommend on whether new mechanisms will have to be developed and if so, which mechanisms (e.g., a new item in the Ontario Schedule of Benefits, Physician Services) or funding under a QBP group.
  • Identify the main decision makers, lay out the typical path towards obtaining reimbursement on a national and a provincial level, including milestones and typical timelines and provide an initial reimbursement strategy for the device in Canada.

Reimbursement Planning for Decision Makers in Canada

According to the conclusions in the Reimbursement Landscape, we devise the plan for developing the required evidence for Canadian decision makers, such as Health Quality Ontario (HQO) and its advisory subcommittee: Ontario Health Technology Advisory Committee (OHTAC). This includes the development of:

  • Value Story: Puts forward the claims for clinical and economic benefits associated with the use of the new device in the eyes of the relevant decision makers and would serve as the basis for the Economic Model.
  • Economic Model: Highlights the economic benefits of the new device from the perspective of decision makers in Canada. May identify specific outcomes data that should be added to future clinical study protocols.
  • Clinical Data: Recommendations for adjustments and modifications of any planned clinical studies in order to generate the required reimbursement-related evidence for decision makers.
  • Decision Makers' Feedback: Conduct interviews with the identified decision makers in Canada, utilizing Mediclever's network of local clinicians, payer representatives and other stakeholders, to obtain their feedback regarding the developed value story, the economic model and the reimbursement aspects of the planned clinical study.


Depending upon the existence, or the lack of, applicable reimbursement mechanisms (as identified in the Reimbursement Landscape step), we will conduct the following activities:

  • Billing Guide: Develop a set of instructions guiding physicians and other healthcare providers how to obtain reimbursement following the use of the new device.
  • Reimbursement Applications: Work with the relevant medical societies and the appropriate clinical section of the provincial medical association (e.g., Ontario Medical Association (OMA)), to submit proposals to the Physician Services Payment Committee (PSPC). Collaborate with university hospitals to apply for new reimbursement mechanisms, such as add-on funding from provincial/territorial ministries of health or earmarked budgets for specific technologies/programs.
  • Pilot Projects: Initiate pilot projects with different provinces and territories.

Flat fees, concrete timelines, and support through your entire reimbursement process

Local Presence and Experience in:

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