Pharmaceutical Reimbursement Model Survey Form
Please complete this survey to help us understand current pharmaceutical reimbursement models. Your responses are confidential and will be used for research and improvement purposes.
Organization Name
*
Organization Type
*
Please Select
Pharmaceutical Manufacturer
Payer (Health Plan/Insurance)
Pharmacy Benefit Manager (PBM)
Provider Organization
Consultancy/Research
Other
Which reimbursement model(s) does your organization currently use?
*
Fee-for-Service
Value-Based Contracting
Bundled Payments
Capitation
Outcomes-Based Agreements
Other
Which drugs or product categories are covered by your reimbursement model(s)?
*
What is the payer mix for your organization?
*
Commercial
Medicare
Medicaid
Self-Pay
Other
Describe your pricing and/or rebate structure for pharmaceuticals.
*
Are prior authorization or step therapy requirements in place?
*
Prior Authorization Required
Step Therapy Required
Both
Neither
What data sources are used to evaluate reimbursement outcomes?
*
Claims Data
Electronic Health Records (EHR)
Patient-Reported Outcomes
Pharmacy Data
Other
What are the key challenges your organization faces regarding pharmaceutical reimbursement?
*
How satisfied are you with your current reimbursement model(s)?
*
1
2
3
4
5
Please provide any additional comments or insights.
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