Payer Update, April 2022

Payer Update

Payer Team Update

The Payer Team has been working with several HTCs on payer relations and payer contracting issues. The results to date have been very favorable. The Team has helped HTCs retain, add and bring patients back on the HTCs Pharmacy Program.

As you can imagine, insurance and utilization data are key elements in solving your payer relations and contracting issues. The Alliance Team is here to help you organize your data and work with you on your payer issues. Below are the key steps in working together on your payer issues.

  1. Complete the HTC Patient Insurance & Bleeding Disorder Product Utilization Spreadsheet (available here)
  2. Complete the HTC Insurance Questionnaire (available here)

This data will provide you and the Alliance Team the necessary baseline information needed to evaluate your issues and begin creating a strategy to work together to solve your payer issues. However, it is very likely additional information will be needed and may likely include patient protected health information (PHI). Since PHI may be needed to solve payer issues, the Hemophilia Alliance has been signing Business Associate Agreements (BAAs) with HTCs. With signed BAAs the Alliance Team can have patient specific discussions with the insurance payers and insurance brokers/consultants. This has been extremely beneficial in helping solve payer relations and contracting issues.

Do you have payer relations and contracting issues? Contact an Alliance Team member to assist in solving payer issues. Remember, WE WORK FOR YOU!

Also in this Issue…

Notes from Joe
· Update on Alliance Strategic Planning

Alliance Member Highlight
· Multidisciplinary Care in the Management of Heavy Menstrual Bleeding and Blood Disorders

Legal Update
· The Do’s and Don’ts of Contract Pharmacies in 340B Discount Drug Program for HTCs

Washington Update
· Preparing for the End of the COVID-19 Public Health Emergency

Notes from the Community
· Announcing the Hemophilia Alliance Foundation 3rd Annual Innovation Grant