Payer Update, August 2019

Payer Update

Payer Relations Update
By Jeff Amond

Do you remember this article from last year?

Too much work and too little time. That is how I felt most every day when I worked at an HTC. That feeling is all too common for many HTC’s across the country. As a Social Worker/Insurance Specialist at my former HTC, most of my time was spent helping our current clotting factor pharmacy patients with their insurance and financial issues. When we lost a clotting factor patient to a specialty pharmacy, I just didn’t have the time nor the resources to take on that fight. The good news for all of you out there who also struggle with this problem is that myself along with the rest of the Hemophilia Alliance Team have the time and the resources to help. Let us help you win back the clotting factor business to your center. Let us help with your insurance issues. We are only a phone call or email away.

The great news is that more and more HTCs have followed up on this request. In addition, more and more HTCs are setting up a standing call (monthly, quarterly) with their payer team contact to address ongoing issues and/or to alert us to new ones. We are showing good success for those HTCs that have reached out to us, but what does SUCCESS really mean. I looked to the definition of success for answers. Part of the definition of success states “a favorable or desired outcome”.

Was it a favorable or desired outcome when the Hemophilia Alliance Team was able to get an HTC contracted as an in-network provider? Was it a favorable or desired outcome for an HTC when the Hemophilia Alliance Team was able to win back the pharmacy business for a patient they had lost to a specialty pharmacy? Was it a favorable or desired outcome for an HTC when the Hemophilia Alliance Team was able help them retain the pharmacy business for a patient? The answer to all these questions is YES. We are having SUCCESS and we can have SUCCESS for you.

Here’s what one HTC reported about a success story from working with the Hemophilia Alliance:

Thank you to the Hemophilia Alliance Network Services (HANS) team for our recent success in adding a self-funded employer health plan to our factor program. The Center was only aware of the opportunity through HANS’ work with insurance brokers. Working with Jeff A. was a pleasure as he thoroughly managed the process from start to finish. He made it very easy for us. Price points were discussed, a letter of agreement was presented, and assistance is being provided with transitioning the patient to our center’s pharmacy. We are certain that the insurance broker has taken notice of the positive outcomes for the health plan and our center and believe that HANS is now on their radar for additional collaborations.

Please contact the Hemophilia Alliance Team to learn how we can assist your HTC in winning back the business.

Also in this Issue…

Notes from Joe
· The More Things Change…

Alliance Update
· We are Growing!
· Save the Date for an Alliance Session at the ASH Meeting on Making the Running of an HTC Tolerable

Legal Update
· Factor Loans During Emergencies: Truth and Fiction

Operations Update
· Reminder: Sharing HTC Information: Caution is the Best Policy
· Save the Date for an Alliance Session at the ASH Meeting on Making the Running of an HTC Tolerable

Washington Update


Team Alliance Contact Information

We work for you! Please don’t hesitate to contact any of us with any questions or concerns:

Name Email Phone
Joe Pugliese joe@hemoalliance.org 215-439-7173
Sean Singh sean@hemoalliance.org 727-388-7326
Jeff Blake jeff@hemoalliance.org 317-657-5913
Jeff Amond amond@hemoalliance.org 608-206-3132
Johanna Gray, MPA jgray@dc-crd.com 202-484-1100
Elizabeth Karan ekaran@feldsmantucker.com 202-466-8960
Roland P. Lamy, Jr. roland@hemoalliance.org 603-491-0853
Dr. George L. Oestrich, Pharm.D., MPA george@gloetal.com 573-230-7075
Ellen Riker eriker@dc-crd.com 202-484-1100
Mark Plencner mark@hemoalliance.org 701-318-2910
Michael B. Glomb MGlomb@ftlf.com 202-466-8960
Theresa Parker theresa@hemoalliance.org
Karen Bowe
Joel Bellucci webmaster@hemoalliance.org 727-504-0491