Brian Abraham
Senior Director, Market Access & Patient Services
专长:
Brian Abraham, Director of Revenue Management Solutions at EVERSANA™, helps medical technology and biopharma companies develop and execute strategies around coding, coverage and payment for innovative medical technology products. He has 20 years of experience in various therapeutic areas inside companies such as MedImmune (now part of AstraZeneca), IBA Molecular, and Nuo Therapeutics, as well consulting to them. Brian has built reimbursement strategies and teams from early stage through commercialization and worked closely with the Centers for Medicare and Medicaid Services (CMS) on technical and policy issues, including during his time at the Medical Imaging Technology Alliance (MITA). Throughout his career, he has successfully built strategies and teams for market access and reimbursement. Brian earned a bachelor’s degree in Government from the College of William & Mary and a master’s degree in Public Administration from the George Washington University.
Articles by Brian Abraham
Commercializing Digital Health as Durable Medical Equipment: A Conversation with BearingOn.Health
Join EVERSANA’s Brian Abraham, Senior Director of Market Access and Patient Access, as he engages in a thought-provoking conversation with Adam Kaufman of BearingOn.Health. Together, they unravel the complexities surrounding digital health commercialization and reimbursement models, shedding light on the regulatory, pricing, and market access implications. In this exclusive discussion, Brian Abraham and Adam Kaufman […]
Understanding the Inflation Reduction Act: Drug Price Negotiation
In this second of a series, we explore the details known so far about Medicare drug price negotiation resulting from the implementation of the Inflation Reduction Act. The Centers for Medicare and Medicaid Services (CMS) has gradually been releasing guidance for manufacturers on the negotiation process. As this information has been released, Merck and the […]
Breaking Down Q1 2023 Digital Health Policy Updates
Insights and Implications on AI/ML Software, Companion Apps for Pharma, Digital Diagnostics, VR Software, Breakthrough Devices, and More There was a barrage of activity by FDA in Digital Health at the end of 2022, including the wind-down of the Digital Health Pre-Certification program, final guidance on Clinical Decision Support Software, Mobile Medical Applications, Medical Device […]
Understanding the Inflation Reduction Act: Inflation Rebates
Prescription drug manufacturers routinely implement price increases for a variety of reasons that support their business. With the passage of the Inflation Reduction Act late in 2022, Congress added a twist to these price increases. One provision of the Act, also known as the IRA, implements rebates from pharmaceutical companies to Medicare for price increases […]
Bringing a CPT Code to Life to Help in the Fight Against Cancer
An interview with Navid Alipour, CEO of CureMatch, and Brian Abraham, Sr. Director, Market Access & Patient Services with EVERSANA On January 1, CureMatch, a leader in precision medicine that has developed a unique analytical platform to solve the therapeutic complexity and match the best therapy options to the unique molecular makeup of a patient’s […]
AMA Scheduled to Deliberate Potential Approval of Additional Digital Medicine CPT Codes
As part of its upcoming meeting in mid-September, members of the American Medical Association’s (AMA) CPT Editorial Panel will consider several new Current Procedural Terminology (CPT) codes that identify digital diagnostic and therapeutic procedures. Between this CPT Editorial Panel meeting and the proposed rule from the Centers for Medicare and Medicaid Services (CMS) previously discussed, […]
Reimbursement Landscape for Digital Medicine Continues to Advance with CMS
The Centers for Medicare and Medicaid Services (CMS) recently announced several new payment and coding proposals that, once finalized, would recognize and advance the use of digital diagnostic and therapeutic modalities. In this week’s update, we provide information on the new payment rules the CMS proposed for Calendar Year 2023. In our next update, we […]
New Legislation Supports Payment for Digital Therapeutics
Earlier this month, the Access to Digital Prescription Therapeutics Act of 2022 was introduced by Rep. Mike Thompson (D-CA) to the U.S. House of Representatives as H.R. 7051 and by Sen. Shelley Moore Capito (R-WV) to the U.S. Senate as S. 3791. This precedent-setting legislation demonstrates the bicameral, bipartisan commitment to promoting the use of […]
Prescription Digital Therapeutics Coding: A Good First Step by CMS
The Centers for Medicare and Medicaid Services (CMS) recently issued a new code under the Healthcare Common Procedural Coding System (HCPCS) regarding prescription digital therapeutics (PDTs). These types of therapies are generally app- or device-based and can be used in any therapeutic category. This is certainly an exciting development for the PDT sector, as many […]
Breaking News: Updates on Digital Medicine Coding and Payment
Over the past several months, we have been following the activities of the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) regarding coding and payment, respectively, for digital medicine products. Both organizations made significant steps forward in the past few weeks to include some of these innovative products in the […]
TOP NEWS: CMS Proposes Repeal on Medicare Coverage of Innovative Technologies Initiative
In a reversal of its upcoming policy to cover breakthrough designated medical devices, the Centers for Medicare and Medicaid Services (CMS) on Monday issued a proposed rule that would completely repeal the Medicare Coverage of Innovative Technologies (MCIT) initiative, and it would not go into effect in December of this year. Their reasoning is as […]
American Medical Association Discusses New CPT Codes to Identify Digital Health Services
In our last update, we discussed the proposed rule that the Centers for Medicare and Medicaid Services (CMS) issued regarding the addition of certain Current Procedural Terminology (CPT®) codes to identify remote therapeutic monitoring (RTM) in parallel to the existing remote physiological monitoring (RPM) codes and their expected payment rates. Now we’re looking at what […]
CMS Releases Remote Therapeutic Monitoring Codes for 2022
The Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare physician fee schedule regulation for 2022, which includes an analysis and payment calculations for the new Remote Therapeutic Monitoring (RTM) CPT codes issued by the American Medical Association (AMA) late last year. As announced in earlier this year, these codes may enable indirect […]
News Alert: MCIT Program Delayed Until December
The Centers for Medicare and Medicaid Services (CMS) again delayed implementation of the Medicare Coverage of Innovative Technology (MCIT) program, now until December 15, 2021. The program, as described in the current and preceding rules, will provide automatic Medicare coverage for four years to medical devices designated as breakthrough and authorized for marketing by the […]
News Alert: MCIT Implementation Delayed
On Friday, March 12, the Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule with Comment (IFC) delaying the effective date of the Medicare Coverage of Innovative Technologies (MCIT) initiative from March 15 to May 15, 2021. In postponing the implementation date, CMS cited the President’s Executive Order of January 20, 2021, […]
Webinar: Drug Pricing and Reporting Regulatory Updates Part 1
Pharmaceutical companies in the U.S. are navigating President Biden’s new administration and legislative changes that are affecting pricing and regulatory actions. One of these changes includes the regulatory freeze ordered for actions made in the final two months of the Trump administration, which has paused Medicare Part B and Medicare Part D legislation as well. In part one of our drug pricing and reporting […]
Reimbursement May Be on the Way for Remote Therapeutic Monitoring
The American Medical Association (AMA) manages the procedure code set that physicians and other healthcare professionals use to identify the services for which they bill. These codes are commonly known as the CPT® code set, which stands for Current Procedural Terminology, and are the standard billing lexicon for medical services. Currently, four CPT codes identify […]
Drug Pricing And Drug Price Reporting Regulatory Update
As the new president and Congress begin their terms, EVERSANA would like to provide an update on recent legislative and regulatory actions that affect drug pricing and price reporting. The Centers for Medicare and Medicaid Services (CMS) issued this interim final rule on November 20, 2020 (85 Fed Reg 76180-76259), requiring a revised calculation of […]
CMS Adopts Automatic Medicare Coverage of Breakthrough Devices
The Centers for Medicare and Medicaid Services (CMS) on January 12 finalized its proposal of Medicare Coverage of Innovative Technology (MCIT), an additional pathway of coverage for breakthrough-designated medical devices, providing timelines and clarifying definitions of eligible items. CMS initially proposed this rule on August 31, 2020, and EVERSANA’s initial analysis is provided here. The […]