Jeff Knappen Email & Phone Number

Kansas City, Missouri Area

The Government Payer Lead, Gene Therapy is responsible for an assigned mix of government payers which includes Fee for Service State Medicaid (FFS Medicaid), Managed Medicaid (MMC) and Medicare Administrative Contractors (MAC) Jurisdictions. Responsibilities include execution of key business strategies in assigned government payers to advance access for patients with rare diseases who would benefit from Spark Therapeutics' portfolio of Gene Therapy products. Includes but not limited to a high level of clinical expertise, in-depth understanding of the Coverage & Reimbursement landscape, stakeholder interactions, and patient support.

Engaged by senior leadership to influence / guide health policy, coding, coverage, and reimbursement changes / challenges with public / private payers, and providing managed care support across 7 states as a Medical Policy Expert on a newly created team. Developed strategic business relationships w/ third-party payers, including Medicare Contractors, State Medicaid Agencies, policy makers and KOLs. Provided education and information to assist in the development and revision of coverage and payment policies relative to injectable biologicals and new technologies in payer medical and pharmacy benefit plans. Identified, qualified, and educated KOLs and physician advocates. Held full accountability for bidding and pull-through activities for State Medicaid contracts, and leveraged resources to move new and existing products to preferred or reimbursed status.Key Achievements:✓ Executed successful advocate-driven initiative and submission of formal comments during Open Draft BTX policy comment period, which resulted in WPS MAC posting evidence-based policy and referenced class labeling clearly differentiating Botulinum toxin products for 4.5 million lives.✓ Converted LCDs at Medicare MAC Jurisdictions (WPS, FCSO) to maintain parity during ICD-9 to ICD-10 transition, preserving access for 9 million FFS lives.✓ Secured coverage for Liletta with AR State Medicaid in 2017. ✓ Convinced State of Kansas to allow coverage for Bariatric procedures for 35,000 employees.✓ Influenced policy language, coding, and attained class labeling into the Health Care Services Corporation (HCSC) Botulinum Toxin Policy as a "policy expert." Policy Analysts advanced policy to a Level 4 with critical language to distinguish toxin products. ✓ Earned Peer Award (2013, 2015), RHP of the Year (2011), Policy Impact Commercial Award (2011), Working as “One” Award (2011), Excellence in Advocacy (2008), Award for Excellence (2008), and President's Club (2005).

Promoted to newly created Reimbursement Account Management Team, charged with preparing for new indications and focusing on challenges in both Payer and Provider markets. Interfaced on a daily basis with Medicare Contractors and State Medicaid Agencies, and supported MCO team for all Botox medical policy issues. Coordinated and executed strategic plans to address Botox reimbursement needs of healthcare providers. Key Achievements:✓ Protected $100 million market, defended against competition, and preserved "differentiated" Botulinum Toxin policies with Medicare LMRPs across 4 Medicare Carriers. ✓ Established a precedence for Evidence-based coverage preserving market share at 85% for Botulinum Toxin, and maintained / published a Parts A & B "differentiated" LCD with Noridian while navigating MAC consolidation by launching an advocacy campaign across 9 states. ✓ Educated providers on submitting Reconsideration Requests for expansion of specific diagnosis and coding through disseminating clinical information and following all legal and regulatory guidelines. Authored talking points for physician advocates to facilitate dialog between CMDs-A and KOLs, which resulted in coverage on a case-by-case basis.✓ Requested by senior management to provide interim coverage in the Northeastern US (vacant territory) during a new indication launch for Botox Hyperhidrosis, which required meetings with physician advocates, CMD to present clinical information, submitting a formal Reconsideration Request on medical necessity, and conducting a letter writing, telephone, and email campaign to Medical Directors, which resulted addition of Hyperhidrosis to LCD as a covered diagnosis for approximately 2 million lives at Empire (Medicare Carrier).✓ Honored with the Leadership Counsel (2004), National Leadership (2003), and 5-Year Service (2004) Awards.✓ Participated in strategic Differentiation & Advocacy planning committees.

Recruited as 1 of 20 Botox Medical Consultants during expansion to prepare for new indications and eminent competitive threat. Called on office and hospital-based specialists in KS, NE, and MO. Educated clinicians in injection training, Peer-to-peer preceptorships, Cost-Recovery Audits, Reimbursement / Billing In-services, Patient Support Groups, and Payer meetings. Identified and built trusted partnerships with KOL's and Patient Support groups to secure brand loyalty and increase patient access. Key Achievements:✓ Discovered and thwarted a major competitive threat at a State Medicare account (competition stating their product same as Botox and requested LMRP be undifferentiated with equal coverage) by meeting 1-on-1 with CMDs, leveraging relationships with KOLs and Advocates to author evidence-based letters to payer, Patient Support Group leader attending and testifying at an open meeting, and AGN submitting formal comment. CMDs followed evidence-based decision making and LMRP published as differentiated, which set a future precedence. ✓ Preserved $1 million in business with a Top 10 account following threat to halt utilization of Botox due to significant reimbursement challenges by discussing billing issues and potential solutions, conducting extensive Cost Recovery Audit, and leveraging resources. ✓ Increased sales 30% and maintained 100% of Botox injectors despite Buy & Bill challenges by providing educational in-services to providers and billing staff. ✓ Recognized with the Award for Excellence (2001), Spirit Award (2001) and Leadership Council Award (2000) for outstanding performance.✓ Chosen as liaison for co-marketing partnership initiative with Medtronic, which increased exposure in Hospital and Rehabilitation sites of service. ✓ Instrumental in building the "Train the Trainer" program designed to develop KOL's and provide preceptorship training for new injectors.

Promoted to provide leadership, achieve sales and market share objective, and launch new products into the Women's Healthcare Marketplace across a 3-state area. Recruited, interviewed, hired, trained, established goals, coached, and evaluated a 10-member sales force. Conducted field rides to observe and provide input on sales representatives selling and product / pull-through messaging capabilities. Executed POA activities and maintained call priorities to drive business. Key Achievements:✓ Achieved TRX market share of approximately 4% following the launch of Mircette despite hiring and training 10 entry-level pharmaceutical representatives by providing extensive training, field rides, and leadership to ensure team's and product's success.✓ Prevented decline in sales and market share, and managed patient safety concerns following unfavorable clinical data released in a leading journal (Lancet) for 2 OC products by leveraging KOL and high-volume prescriber relationships, and countering review with substantial safety data.

(1992-1997)Recruited during company's expansion to launch new Anesthesia and Women's Healthcare products. Promoted pharmaceutical product portfolio comprised of anesthesia, ICU, OB/GYN, Psychiatry, and Urology products to office and hospital-based specialty physicians. Identified and built strong rapport with high volume prescribers / staff and six residency programs, and communicated product's features and benefits from a clinical messaging standpoint. Key Achievements:✓ Achieved national ranking in Top 10%, and increased TRX market share 0-8.5% and NRX market share from 0-11% following successful launch of new oral contraceptive pill into a highly competitive marketplace despite market leader J&J-Ortho promoting same product under a different brand name.✓ Increased market share from 0 to 4.5% and ranked 27th out of 150 representatives subsequent to launch of Remeron into the crowded mental health marketplace without physician relationships by incorporating a persistent call rotation with high-volume prescribers and focusing on unique clinical profile and a specific patient population.✓ Generated 80+% market share and achieved market leader status for TICE BCG despite competitor's marketing campaign focused on unfounded patient safety issues.✓ Planned and coordinated off-site events for hospital providers, residents, students, and staff to gain access and build rapport with large group practices, which increased call frequency three-fold and allowed unfettered access to observe surgery with key Anesthesia, OB-GYN, and Urology groups.✓ Nominated for Representative of the Year in 1994 and 1995 for outstanding performance.

Responsible for the sale and promotion of quality name brand biscuit products to the professional retail and wholesale trade.

Bs, Finance

Regiestered Medical Coder (Rmc), Reimbursement & Coding