National Comprehensive Cancer Network

Educational Events & Programs

NCCN Academy for Excellence & Leadership in Oncology™
School of Pharmaceutical & Biotech Business

Public and Private Payors: Process, Policy and Practice in Coverage and Reimbursement

Entry-Level Module or Experienced Module

This module reviews the use of coverage policy, reimbursement levels, preauthorization, patient co-pay, disease management, specialty pharmacy, and other payor trends with an eye to the types of data and information needed to achieve positive reviews and decisions from oncology payors. The following topics may be included:

  • The structure, processes, and programs used by payors to manage and control the use of drugs, devices, procedures, and techniques
  • Inherent differences and “pressure points” between public and private payors
  • Specific national payors and other stakeholder organizations, including United Healthcare, FDA, CMS, TEC, ECRI, Hays, AMCP, DOD, AHRQ, and NIHCR, with respect to their impact and influence on payor policies and decisions
  • The role of both insured and self-insured employers in benefit design and coverage policy