Payer Update, April 2023

Payer Update

by Jeff Blake, Senior Vice President Member & Community Relations

The Hemophilia Alliance Team continues to develop and enhance our payer relations and contracting opportunities to bring business back to our member HTCs and their pharmacy programs. We have accomplished a lot, but there is so much more that we can do. Below is a summary of the results of bringing business back to HTC pharmacy programs since 2018.

Total new units 1/1/2018 – 12/31/2022 42,683,000
Current opportunities/potential new units 73,859,000

To continue our success and bring more business to HTC pharmacy programs will require teamwork. Payers are contacting us daily to discuss potential solutions to better manage and contain the cost of bleeding disorders care. As you know, we tell payers the best solution is to have an integrated model of care that our member HTCs provide that includes medical and pharmacy services. Payers are listening to our message and bringing more potential opportunities to us. The chart above speaks for itself – in 5 years we have been able to redirect over 42,000,000 units to HTC pharmacy programs and we currently have payer opportunities of almost 74,000,000 units. If we were able to transition these units to HTC pharmacy programs at $0.25/unit margin new pharmacy revenue would be $18,500,000.

So, what do we need to do to bring more business to HTC pharmacy programs? Two things come to mind:

  1. We must be responsive to payers to finalize potential opportunities. We typically have 7 – 10 business days to respond to payer opportunities. How can you help? When a member of the Hemophilia Alliance team contacts you about an opportunity to grow your pharmacy business, be responsive so we can respond in a timely manner to payers.
  2. Review and sign the Hemophilia Alliance Network Services (HANS) PPO Agreement. We will work with you and your contracting/legal teams to finalize this agreement. This agreement will provide you the opportunity to participate in payer contracts that we have negotiated. We currently have 43 members that have signed the HANS PPO Agreement and, as a result, have had success negotiating agreements with regional payers in pockets of the country. To have an effective national network of HTCs and their pharmacy programs we need at least 80 members to sign the HANS PPO Agreement. As HANS continues to gain momentum, we want all of our member HTCs to have immediate access to available contracts in order to continue providing the best care and service to HTC patients. Please reach out if you or anyone at your institution has questions about this opportunity.

To learn more about our payer activities, please contact me at or a member of the Hemophilia Alliance Team.

Also in this Issue…

Notes from Joe
· Dateline: Orlando, Florida

Washington Update
· Reminder: Register for the June Hemophilia Alliance Hill Day!

Legal Update
· 340B Contract Pharmacy Services Agreement: Some Rules and Many Pitfalls

Alliance Update
· We Need Your Help: Look for the HTC Needs Assessment

Notes from the Community
· The Hemophilia Alliance Foundation Update: 2023 Project/Patient Assistance Grants
· NHF – 2023 Unite for Bleeding Disorders National Walk and the HTC Wall of Walkers Challenge
· Update on FAIR Time for Women
· Webinar Announcement from the Foundation for Women and Girls with Bleeding Disorders

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