Member and Community Relations Update

The MCR Team Is Here to Support Your HTC with Letters of Agreement, Single Case Agreements, and Gene Therapy Reimbursement

by The Member & Community Relations Team

The Member and Community Relations (MCR) team works closely with our member Hemophilia Treatment Centers (HTCs), ensuring that member HTCs have the expertise, resources, and public support to sustain their integrated clinical and pharmacy services for individuals with bleeding and clotting disorders.

Typically, the MCR team identifies opportunities for HTCs to dispense medications directly to patients through insurance payer and PBM contract negotiations, or through the Hemophilia Alliance Network Services (HANS). However, as treatment options and payer policies continue to evolve, member HTCs are facing new challenges in dispensing to their patients through their 340B programs. In these circumstances, Letters of Agreement (LOAs) or Single Case Agreements (SCAs) can be a path forward for HTC 340B programs to dispense to their patients, especially when it comes to self-insured plans.

Here is one recent example. A member HTC notified Hemophilia Alliance staff about a payer issue that would have resulted in one of their long-time hemophilia patients being forced to discontinue use of the HTC pharmacy. Working with the HTC, the MCR was able to identify the broker who worked with the patient’s employer and the payer to get an exception for the HTC to continue to service the patient from the HTC pharmacy. The payer and HTC are currently working to formalize this arrangement in an LOA.

In another recent case, a member HTC had a patient whose employer incorporated an alternative funding program (AFP) on their self-insured plan. The Hemophilia Alliance had previously worked with the HTC to establish an LOA with that employer, allowing the HTC’s 340B pharmacy to dispense to the patient – while controlling costs for the patient’s employer. When the employer added the AFP to their plan for 2025, the employer opted against applying the AFP to this patient’s life-saving bleeding disorder medications, and the patient continued to access his medications through the HTC pursuant to the LOA. Midway through the year, the patient expressed an interest in receiving gene therapy. Hemophilia Alliance staff initiated conversations with the broker of record for the employer; once it was determined the patient was a clinically appropriate candidate for gene therapy, the MCR, broker, and employer opened up dialog on a path forward for the patient. That path eventually led to a SCA with the HTC that outlined the reimbursement rate, the claims submission parameters (within 30 but no later than 45 days from the date of service), and payment parameters (timely but no greater than 30 days). The HTC submitted its claim in the afternoon after the infusion occurred and received payment in full six (6) days later.

These examples highlight how the Hemophilia Alliance and the MCR team are committed to partnering with your center so you can stay focused on what matters most – serving your patients. Whether your team needs assistance with an SCA, LOA, or a gene therapy case, the MCR team’s goal is to ensure your Center has the tools and support needed to secure timely patient access and program sustainability through 340B pharmacy dispensations. We can help you meet your payer challenges with confidence and a smile. 😊 We work for you!