Medical Device Reimbursement Landscape in Canada
The purpose of this step is to understand the current reimbursement environment in Canada. Learn more about reimbursement planning and implementation pathways.
- Clarify the relevant coding systems (CCI), provincial and territorial fee schedules, hospital Quality Based Procedures (QBP), CMG+ payment mechanisms, and payment rates for the specific device or comparable products.
- Identify reimbursement pathways that could be utilized as-is or determine if new mechanisms need to be developed (e.g., new provincial schedule code, hospital QBP inclusion, or CMG+ adjustments).
- Identify the main decision makers, outline the path to obtain reimbursement at provincial and national levels, including milestones, timelines, and an initial strategy for the device in Canada.
Reimbursement Planning for Canadian Medical Device Decision Makers
Based on the Reimbursement Landscape, we develop the plan for generating the required evidence for Canadian decision makers, including provincial health authorities and hospital committees. This includes:
- Value Story: Clinical and economic claims supporting the device, forming the basis for the economic model.
- Economic Model: Highlights economic benefits from the Canadian perspective; may identify specific outcomes for future clinical studies.
- Clinical Data: Recommendations to modify planned clinical studies to generate reimbursement-related evidence.
- Decision Makers' Feedback: Conduct interviews with Canadian decision makers using Mediclever's network of local clinicians, payers, and other stakeholders to obtain feedback on the value story, economic model, and study design.
Implementation
Depending on the existence of applicable reimbursement mechanisms, we conduct:
- Billing Guide: Instructions guiding providers on how to obtain reimbursement for the new device.
- Reimbursement Applications: Submit proposals for provincial schedules, hospital QBP inclusion, and CMG+ adjustments.
- Pilot Projects: Initiate pilot projects with different provinces and territories.
Key Questions About Medical Device Reimbursement in Canada
How long does medical device reimbursement take in Canada?
Timelines vary by province and device type. Typically ranges from several months to over a year.
Which reimbursement pathways exist in Canada?
Reimbursement may involve inclusion in provincial or territorial fee schedules, hospital Quality Based Procedures (QBP), and CMG+ DRG-like systems.
What coding systems are relevant in Canada?
The Canadian Classification of Health Interventions (CCI) and provincial schedule codes are used for procedures and devices.
How do devices obtain funding in Canadian hospitals?
Funding can be obtained through hospital budgets, QBP groups, and provincial ministries of health, often requiring submission of clinical and economic evidence.
Can reimbursement planning start before Health Canada approval?
Planning can begin early, including strategy for evidence generation and pathway identification, but formal reimbursement depends on regulatory approval.
Why Mediclever for Medical Device Reimbursement in Canada?
Mediclever is a specialized reimbursement consultancy supporting medical device manufacturers in Canada with evidence generation, coding, and market access execution. Our team has supported reimbursement strategies across multiple provinces and therapeutic areas.