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Reimbursement strategy

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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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National tariffs for outpatient specialist care and prosthetic care approved in Italy

The Essential Levels of Care (LEA) document from 2017 is the document that defines the guaranteed basket of benefits for Italian population. Annex 4 of the LEA document contains fee-for-service list of outpatient specialist services (including IVD tests) that are guaranteed on the national level. Annex 5 of the LEA document contains the nationally-guaranteed medical aids and prostheses.

Although the LEA document was brought in 2017, the services did not have relevant national tariffs established. So far, the only national tariffs (which are used by the Regions as a reference for developing regional tariffs, which are actually used for reimbursement of services) were from 2012.

In January 2022, a draft decree defining the reimbursement tariffs for the latest 2017 LEA catalog was submitted to the State-Regions Conference for approval. However, it was rejected, and in September 2022, a new draft decree was submitted.

On April 19, 2023, the Italian Ministry of Health announced that the State-Regions Conference approved the national tariffs for outpatient specialist care and prosthetic care. These tariffs will be applied to Annexes 4 (outpatient specialist care) and 5 (prosthetic care) of the Essential Levels of Care (LEA) document from 2017. New tariffs for outpatient specialist care will enter into force in January 2024, and the tariffs for prosthetic care will enter into force on April 1, 2024.

More details can be found here and here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Contact us to get a free, three-month, no-obligation trial.