Credibility

• The CDE has a vast network of multi-specialist clinicians and Key Opinion Leaders
• The CDE is accredited with the Council for Medical Schemes as a
  Managed Care Organisation for Active Disease Risk Management Services in:

Well-positioned

• As a 3rd party, the reimbursement support services are seen by the funders to be independent of the company behind a product
• To work within the boundaries of the market access requirements as a trusted 3rd party with years of experience in dealing with funders.
• To submit correct documentation timeously and in the format required by the funders. This alleviates multiple interactions with companies’ Medical Advisory Service to facilitate successful reimbursement outcomes.
• Additionally, with the implementation of POPIA act and stricter regulations on the Pharmaceutical industry, many companies are now restricted in their access to Health Consumer information affecting said service offering.

Affordable

• The CDE Reimbursement Support Programme is more cost-effective than running an in-house programme.
• The ROI generated by increased sales volumes will more than cover the costs.

Low-risk

• The CDE has a fully developed Pharmacovigilance Department set up to comply with company’s Health Consumer Safety and Regulatory Departments.
• The CDE’s CRF 21-accredited electronic system provides full audit trails to ensure all POPIA compliance and governance needs are met.

Gravitas

• The CDE has a dedicated team equipped with the latest requirements and formularies for all healthcare funders.
• Where appropriate, motivations are endorsed by an independent team of senior physicians/specialists.

Success

• Reportable higher successful reimbursement motivation outcomes
• Increased retention rates to stay on therapy and improve clinical outcomes

The CDE Reimbursement Support Programme facilitates:

• Access
• Adoption
• Aherence and
• Persistence

Access - Overcome barriers to accessing a product:

• Patient advocacy
• Formulary advice
• Assistance to ensure motivations meet funding criteria as far as possible
• If applicable and required provision of Specialist reviews

Adoption - Obtaining the first script and getting it filled:

• First script written
• Script fulfilled
• Support for initiation

Adherence – Ensuring that the product is used as prescribed to obtain desired outcomes:

• Monthly prescription refills collected

Persistence – Ensuring longevity on the product

• Repeat prescriptions
• Repeat motivations

The CDE:

• engage with funders to advocate for health consumer access to recommended products.
• provide specialist reviews and motivation for expensive, low volume products.
• increase access by better understanding the appropriateness of a particular product, for a particular person, in a particular market segment.
• increase adoption by overcoming the obstacles to accessing a product, without a co-pay, by utilising legitimate processes to obtain funding.
• increase adherence by supporting the health consumer to achieve outcomes that can be reported to the funder, to ensure ongoing access to the product.
• maintain persistence by obtaining proof of efficacy, remotivating for continued access within the stipulated time frame and sourcing the required supporting documentation.

The CDE is in uniquely positioned to drive this reimbursement assistance service as an outsourced anonymous vendor, with the following benefits:

• Connecting the health consumer and healthcare team to the company, on a de-identified basis, to allow better insight into the clinical environment surrounding health consumers and healthcare providers.
• Relieving pressure on the medical advisory department and allowing them to focus on their main priorities.
• Providing market access insider knowledge in the Funder world regarding products and funding rules
• Providing an opportunity to deploy sales teams to support the healthcare network, thus increasing proficiency and efficacy. This provides effective closing of gaps between sales teams and real-world evidence.
• Gaining clinical insight to train sales teams on effective upskilling on healthcare providers or the funding environment through various motivation principles.

• CDE’s approach is more comprehensive, intensive, complies to POPIA and health consumer safety regulations and delivers greater results when working within individual practices;
• CDE’s case managers only assist practices by taking away the administrative burden of doing reimbursement motivations for your health consumers.
• The health consumer remains in each individual practice indefinitely and is never moved to another practice.
• CDE assist with the motivation on the products that the healthcare practitioners wish to prescribe and motivate for.
• CDE assist with further motivations should the funders decline or levy a hefty co-pay to the health consumer. They utilise their various funder channels, provided the motivation meets clinical funding criteria, to meet the full reimbursement of a product and pursue this on behalf of the healthcare practitioner.
• CDE help increase awareness around compliance management to benefit design (consultations, medication and pathology).
• Assist with expert assessment and motivation on high-cost devices or medications for medical schemes
• CDE act within Appropriate Medicine Management according to published and accepted guidelines and algorithms for conditions.

The standard reimbursement process involves:

• Constant communications between all parties:
• Medical Practice:

Assist and guide on providing minimum needed information to ethically complete motivations for clinical and funding criteria.

• Funder:

Multiple interactions to ensure motivation is captured and moves according to channels. Engagement of medical advisory team on the true reason for the decline and possible next steps.

• Health Consumer:

Keep health consumer abreast of motivation progress

• Complete anonymity where health consumers’ information is protected
• Full consent in place before any action on health consumers’ information
• CDE pursues each case continually to gain success. This means that the CDE will drive a reimbursement application along all possible avenues within the funder environment to obtain the best possible chance for successful outcomes.
• Assistance with a motivation should reimbursement attract a co-pay, either through appeal or exgratia.

Please CLICK HERE to download more information on the CDE Reimbursement Support Programme.

Outcomes

• An informed health consumer
• Improved adherence to care
• Escalation of concerns back to healthcare providers that health consumers may not disclose during consultations

It will not

• Interfere with the expert care given by the healthcare providers
• Interfere with prescribed medication
• Question the healthcare providers’expertise

• The CDE philosophy is that the health consumers always comes first. The CDE appreciates that, in most instances, health consumers are enduring dire situations and/or difficult transitions and thus advocate the importance of always addressing the client with compassion. Communication is key when it is on the health consumer’s level of understanding.
• The CDE endeavour to establish an intimate relationship with the health consumers thereby providing a portal to address the necessary “others” on their behalf. It provides assistance to the clients to make informed by acting as advocates on their behalf when considering clinical status and treatment options.
• Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client-centered.
• Help health consumers achieve wellness and autonomy through support programmes aiming to increase adherence and improve quality of life.
• Take the extra mile and interact with health consumers to keep track of progress and ensure satisfaction.
• Each person is unique and requires critical and clear thinking, to find solutions to problems whilst adhering to professional standards as outlined by protocols, rules and regulations.
• Assist health consumers with a thorough understanding and navigation of pharmaceutical regulations, protection of personal information and the medical funder environment.

• Collection of real-world evidence (data) can be utilised by companies to influence decsions as well as provide knowledge of medical funders/providers.
• Detailed reporting on products and program analytics such as doctors prescribing habits, referrals, patient enrolments, adherence, optimisations, prescription refills, clinical parameters, patient satisfaction.
• Quality assurance to ensure that all standards are met by both parties.

Please CLICK HERE to download more information on the CDE Patient Support Programme.

• Study feasibility process
• Good clinical practice and fully equipped clinical trial centre network
• Health consumer education and electronic diaries
• Remote data capturing and Electronic data transfer
• Regulatory submissions
• Contract and budget review

Each centre is equipped with the following facilities:

• Waiting rooms
• Consultation Rooms
• Work Stations
• ECG Rooms
• Laboratory and Equipment Rooms
• Procedure Rooms
• Dedicated Monitoring areas
• Boardrooms
• Administrative Offices
• WiFi
• Fire Detection Systems
• Full Security
• Generators
• Bathrooms
• Storage Facilities
• Temperature and Access controlled Pharmacies

Each site is fully equipped with the following:

• Access controlled refrigerators and freezers (-30 to -20 ˚C)
• Continuous temperature devices
• Blood pressure machines
• Centrifuge
• Nextsight for retinal photography
• ECG machines
• Weight and height scales
• Automated external defibrillator
• Emergency trolley
• Anaphylaxis kit
• Nebulisers
• ECHO
• Doplar
• Glucose monitoring devices
• *Selected in-house pathology lab sites

The CDE has been involved in many critical clinical trials with the following companies:

• Abbvie Inc
• Astra-Zeneca
• Bayer
• Boehringer Ingelheim
• Bristol-Myers Squibb
• Covance/Pfizer
• GlaxoSmithKline
• Intarcia Therapeutics
• Janssen
• Lilly & Company
• Merck/Parexel
• Mylan
• Novo Nordisk
• Sanofi

This business unit is dedicated to complying with pharmacovigilance and quality assurance in delivering services, whilst adhering to governance.

The following applies:

• Record Cases Information - complete all necessary forms accurately and produce statistical reports.
• Reporting of all adverse events to the health consumer safety department and maintain and adhere to good documentation practice to manage the vast amount of information received.
• Ensuring time management and organizational requirements are fulfilled: Case managers have multiple clients with various needs and are in various stages of need.
• Ensuring constant feedback individual companies to ensure the practical flow of information. Timeous management of case assignments, draft service palns and reviews of case progress will determine case closure.
• Maintaining Standard operating procedures relevant to the programme to ensure all parties are knowledgeable about procedures.

Please CLICK HERE to download more information on CDE Clinical Trials.