In this Issue…
Notes from Joe
· April Snow Showers and Travels
· Thank you to Participants in the Alliance Hill Day!
· Payer Team Success Story
· The UGG’s Procurement Standards Get Slightly Less Arduous
· Alliance Recruiting for a Director, Payer Relations for the Western United States
· Mark Plencner Awarded North Dakota Health System Pharmacist of the Year Award!
· Save the Date for 2018 Events!
Notes from the Community
· NIH State of the Science Workshop
· VWD Connect Foundation Announces the 2018 National Type 3 Von Willebrand Disease Conference: Making The Connection
Team Alliance Contact Information
Notes from Joe
April Snow Showers and Travels
By Joe Pugliese
It is springtime finally in the northeast and I and Team Alliance members have been all around the country working on your behalf.
First, we were all together for our member meeting in New Orleans, which set a record for attendance. Next, the NHF Chapter leadership meeting was held in San Francisco. The meeting was a high energy event, with a great combination of general and breakout sessions. At the risk of missing others who gave excellent presentations, I have to give a shout out to the Jeremy Griffin and Rich Pezzillo show, which was educational and entertaining session about how and why to make videos. But the highlight of the meeting was the group visit to the Hemophilia AIDS Memorial. Jeannie White and Dana Francis both gave emotional and personal accounts of the HIV tragedy.
The Alliance’s role in the community continues to grow and expand in a number of different ways. We were in attendance at a number of regional meetings in April. Johanna Gray and I attended the Region IX meeting. Johanna presented a Washington update and gave a very motivating pitch on the need for everyone to be involved in advocacy. I could not agree more! The theme of the meeting was “Winter is Coming” and attendees discussed the need for all of us to develop strategies to ensure the sustainability of the comprehensive care model. I’ll again give a shout-out to Ebeneezer Ducore, who demonstrated the risks of poor planning.
Our Washington Hill Day and Physician Meeting was a tremendous success. We started holding the Hill Day in 2012 and it has continued to grow and improve each year. Beyond representatives from dozens of HTCs, we also had 13 patient advocates, 2 manufacturers and the NHF Advocacy Team represented at the meeting. In total, our group had 109 meetings with Senate and House offices. Our educational message was the comprehensive care model works for the people with bleeding disorders in the United States, and indeed is a model of care for like chronic disease states around the world. It is all made possible because of the revenue the centers realize from the 340B Program. HTCs not only produce superior clinical results, but also save the health care system tens of millions of dollars.
Meanwhile, we continue to work on better leveraging the resources of the NHF and Alliance advocacy teams. Teams of NHF and Alliance members presented at recent insurance meetings across the country with a shared message. We have a great story to tell: better clinical outcomes, lower cost of care from emergency room visits, fewer missed days from school and work, less utilization and we typically can save a plan 20-40%. We are enjoying an ever increasing success rate in getting HTCs into networks.
We ended the month at the Hemophilia Federation of America meeting in Cleveland. We were pleased to be recognized at the Circle of Friends event for being the first to offer financial aid to Puerto Rico, whose community still desperately needs help. The community also said a final farewell to Barry Haarde, a man who was an inspiration to so many and left us too soon.
Thanks to All who Participated in Alliance Hill Day!
By Johanna Gray and Ellen Riker
Our thanks to the nearly 80 Alliance members, patient advocates and supporters from manufacturers who participated in the 2018 Alliance Hill Day! Twenty teams had more than 100 meetings to educate Members of Congress and their staffs about HTCs and the federal programs that matter most for us, including the CDC and HRSA grant programs and the 340B Program. With so much Congressional attention being paid to 340B these days, it is vital that we tell our own story of how 340B allows HTCs to provide comprehensive care to patients with bleeding disorders. We are grateful for everyone who came to DC! You can see some photos of our teams meeting with Senators, Representatives, Congressional staff and even an office dog here.
Payer Team Success Story
By Mark Plencner, R. Ph.
Many of the Hemophilia Alliance members are becoming more familiar with the Hemophilia Alliance Network Services (HANS), which incorporated In January 2017. This wholly-owned subsidiary of the Hemophilia Alliance was formed to bridge the gap between HTCs, Payers, PBMs and Employers with the goal of keeping Hemophilia Treatment Centers (HTCs) and their pharmacy programs in network with Payers. This is particularly important when it is an employer utilizing a self-insured health plan with a specialty drug carve out.
Jeff Blake, Roland Lamy, George Oestreich, Jeff Amond and Mark Plencner make up the current Payer Relations Team. Since inception, work has been underway to develop relationships with insurance brokers and consultants, insurance companies, large employers with self-insured health plans, PBMs and third-party claims administrators (TPA).
We know members have varying levels of understanding of how this process works, so I would like to take this opportunity to describe a recent success story.
In late January, we were notified of two users of clotting factor products which had the attention of the insurance broker and the employer. The insurance broker contacted us to see if there was any way HANS could reduce the cost of clotting factor to this national, self-insured plan.
The first order of business was to be sure HANS had an active Non-Disclosure Agreement (NDA) in place between the insurance broker and HANS. Because we’ve previously worked with this insurance broker, the NDA was in place and active. This document allowed the insurance broker to transmit de-identified claims data for the payer team to analyze.
The payer team then contacted the HTCs that were already seeing the members and notified them of the potential return of dispensations to the HTC Pharmacy if we could establish a competitive price point providing savings to the employer’s self-insured health plan. After price point was agreed upon, the payer team finalized the analysis and informed the insurance broker and employer of the potential savings. The decision was then made to transition the members to the HTCs pharmacy programs through a Letter of Agreement (LOA). The payer team and HTCs are now working with the patients and third-party claims administrator to finalize the transition.
Please contact one of the Hemophilia Alliance team members to discuss how we can assist you with your payer relations and contracting issues.
The UGG’s Procurement Standards Get Slightly Less Arduous
By Feldesman Tucker Leifer Fidell LLP
The Uniform Grants Guidance articulates standards with which all federal grant recipients, including HTCs, must comply when acquiring property or services. These requirements, termed the “Procurement Standards,” are set forth at 45 C.F.R. §§ 75.326 through 75.335 and focus primarily on maximizing competition in purchasing. The Procurement Standards are much more prescriptive than prior requirements. Likely for this reason, the Office of Management and Budget repeatedly delayed implementation until the beginning of grantees’ first fiscal year commencing on or after December 26, 2017.
The Procurement Standards define five forms of procurement which vary depending on the dollar amount of the procurement and whether or not multiple bids are possible. The Procurement Standards increase in complexity with increases in the dollar amount of the procurement. Currently,
- Micro-purchase: No competitive quotes are required if management determines that the price is reasonable and the amount is below the Micro-purchase threshold (MPT), which is currently $3,500.
- Small purchase: Includes purchases up to the Simplified Acquisition threshold (SAT), which is currently $150,000. Informal purchasing procedures are acceptable, but price or rate quotes must be obtained from an adequate number of sources.
- Sealed bids: Used for purchases over the Simplified Acquisition Threshold, which is currently $150,000. Under this purchase method, formal solicitation is required. This method is the most common procurement method for construction contracts.
- Competitive proposals: Used for purchases over the Simplified Acquisition Threshold, which is currently $150,000. This procurement method requires formal solicitation, and is used when sealed bids are not appropriate.
- Noncompetitive proposals: Also known as sole-source procurement, this may be appropriate only when specific criteria are met (e.g. item available only from one source, when a public emergency does not allow for the time of the competitive proposal process, when the federal awarding agency authorizes, or after a number of attempts at a competitive process, the competition is deemed inadequate).
Recently, the 2018 NDAA (Pub. L. 115-91, Dec. 2017) increased the statutory definitions of MPT to $10,000 and the SAT to $250,000. These changes have not been codified in regulation, meaning that a conservative approach would be to wait until the government does so to update your procurement policies and procedures. However, the increases are notable because they should make the Procurement Standards less difficult. Specifically, the increase to the MPT should mean that more procurements qualify for the less complex procurement process, and the increase to the SAT should mean fewer procurements qualify for the most complex procurement processes.
Alliance Recruiting for a Director, Payer Relations for the Western United States
The Hemophilia Alliance is currently recruiting for a Director, Payer Relations for the Western United States. This position reports to Jeff Blake, the Senior Vice President Payer Relations of the Alliance. The position is responsible for the payer relations activities of the assigned territory and participating in meetings with patient advocacy organizations. More information on the position and how to apply may be found here. Anyone with questions on the position may reach Jeff Blake.
Mark Plencner Awarded North Dakota Health System Pharmacist of the Year Award!
Mark Plencner, Director on the Payer Team for the Hemophilia Alliance, has received the 2018 North Dakota Health System Pharmacist of the Year Award! Mark was recognized for his outstanding commitment to the profession and dedication to advancing pharmacy practice. The award letter to Mark states,
Your hard work and outstanding efforts have not gone unnoticed. During your 35 years of pharmacy practice you’ve been involved in many aspects of patient care, from the operating room to the Roger Maris Cancer Center and now as a Director for the Hemophilia Alliance. The course of your career and the impact you’ve made upon colleagues, students, and the profession is impressive.
Please join us in recognizing Mark for this awesome accomplishment and well-deserved honor!
Save the Date for 2018 Events!
Save the date for Alliance events in 2018, including:
- September 23-25: Physician Meeting and Alliance Members Meeting in Las Vegas – Register Here
Notes from the Community
NIH State of the Science Workshop
The NHLBI State of the Science (SOS) Workshop will be held on the NIH campus in Bethesda, Maryland on May 15 and 16, 2018. The goal of this workshop is to solicit input from all constituencies within the U.S. hemophilia community, as well as international collaborators, into the development of a coordinated and collaborative national blueprint for future, basic, translational, and clinical research focused on factor VIII (FVIII) immunogenicity and FVIII inhibitor prevention and eradication.
Four pre-workshop Working Group deliberations on scientific priorities, challenges and opportunities will determine the preliminary national blueprint for future research focused on FVIII immunogenicity and FVIII inhibitor prevention and eradication. This draft plan for research prioritization and implementation will be presented to meeting participants for additional discussion, finalization, and subsequent dissemination. Registering participants are also being given the opportunity to sign up for a breakout session led by one of the four Working Groups for the chance to further inform the national agenda on the scientific topic of their choice.
Please click links below for additional info:
VWD Connect Foundation Announces the 2018 National Type 3 Von Willebrand Disease Conference: Making The Connection
Team Alliance Contact Information
We work for you! Please don’t hesitate to contact any of us with any questions or concerns: