Coverage and Reimbursement Roadmap for Women’s Health Innovation

Women's health has long been underserved by a coverage system built around inadequate research, insufficient billing codes, and payers that have been slow to recognize conditions that affect women exclusively, differentially, or disproportionately. Promising innovations stall not for lack of science but for lack of a clear path to payment.

The Milken Institute Women's Health Network's Coverage and Reimbursement Working Group convened a workshop of clinicians, payers, regulators, and innovators to examine the fundamental coverage challenges and barriers shaping women’s health innovation in the United States and to chart a way through them.

The result is the Coverage and Reimbursement Roadmap for Women's Health Innovation, which provides a clear guide to the reimbursement pathway—from concept to patient access—for women's health innovators.

Explore the report for: 

• the nine structural barriers standing between women's health innovations and reimbursement;
• a comparison of the self-pay and payer coverage pathways, and why the choice between them should be made early; and 
• key considerations, optimal timing, and the step-by-step guidance associated with the three primary coverage pathways: self-pay, commercial payer coverage, and public programs (from Medicaid's state-by-state variation to Medicare's four distinct parts).