October 23, 2024
Lantheus (LNTH): Pylarify Medicare Rate Expectations
Key Takeaways: With CMS due to release its CY25 hospital outpatient rule ~Nov. 1, we expect it to finalize separate payments for diagnostic radiopharmaceuticals, though with slight odds to the impact being a ~45% reduction…
October 15, 2024
[INSP, LIVN, NYXH] Sleep Apnea: Codes, Coverage, & Value Accretion
Key Takeaways: We suspect Inspire Medical’s (INSP) next-generation Inspire V implant procedure can secure Medicare coverage / reimbursement under the legacy product’s billing code [CPT 64582: $816], where the shorter procedure time should increase physicians’…
October 9, 2024
Exact Sciences (EXAS): Rate Reversal Prospects
Key Takeaways: With FDA’s early approval of Exact Sciences’ (EXAS) Cologuard Plus last week coming on the heels of CMS’s preliminary rejection of EXAS’s requested 25% rate increase ($636) relative to the legacy product ($509),…
October 9, 2024
Exact Sciences (EXAS): Rate Reversal Prospects
Key Takeaways: With FDA’s early approval of Exact Sciences’ (EXAS) Cologuard Plus last week coming on the heels of CMS’s preliminary rejection of EXAS’s requested 25% rate increase ($636) relative to the legacy product ($509),…
October 8, 2024
[EW, ABT] Tricuspid Coverage & Sales Trajectory
Key Takeaways: As investors look to model out sales of Edwards Lifesciences’ (EW) Evoque tricuspid valve replacement in advance of CMS’s draft National Coverage Determination (NCD), which is expected by ~Dec. 20 (final policy due…