Payer Update, August 2022

Payer Update

The Payer Relations Communication Highway
by Mark Plencner

The Payer Team has been working steadfastly over the last four years to return over 40,000,000 units back to the HTCs by contacting and developing relationships with Insurers, Brokers/Consultants, PBMs and TPAs. Through Letters of Agreement and the broader-reaching HANS PPO Agreement, we have shown that the Hemophilia Alliance through our member HTCs can provide substantial savings to their clients while continuing to provide integrated care – a model that is published and proven superior when patients are seen at an HTC.

The newly formed relationships within the Payers along with our longstanding relationships with the HTCs have resulted in a Communication Superhighway. Our savings model has been very successful. Payers, who previously responded only when contacted through our phone calls and emails, are now contacting the Hemophilia Alliance, or even the HTCs directly, seeking cost savings opportunities.

In a recent example, a pharmacy benefit consultant contacted one of our member HTCs seeking better pricing on clotting factor for a large, self-insured client. The HTC’s pharmacist suggested they contact the Hemophilia Alliance. The consultant emailed us immediately seeking to find out more about the Alliance. After an introductory meeting, the consultant provided us with claims data. We were able to determine the patient was already receiving their medication from the HTC pharmacy program and was being reimbursed at the contracted rate from the payer under the medical benefits. Still, the employer and the consultant wanted to move the patient to another pharmacy and have the claims processed as a pharmacy benefit. Through discussion with the HTC, we were able to provide a suggested saving model to the consultant and employer which would keep the patient at the HTC Pharmacy as well as provide additional savings to the client. The consultant was extremely impressed by the short turnaround time needed to establish a reimbursement rate and complete the individual Letter of Agreement.

The pharmacy benefit consultant then initiated a call with the Hemophilia Alliance to see if we could provide savings for all their members nationally through a Hemophilia Alliance Network Services (HANS) payer contract. We continue our discussions with the consultant and we recently received data on their members that includes more than 20 people with bleeding disorders and over 2,000,000 units of clotting factor and Hemlibra. We are in the process of completing our analysis and are excited about this opportunity.

This is an excellent example of how working together can create excellent opportunities to grow your pharmacy business and increase HTC pharmacy market share nationally. The key to success in working on your behalf is a timely response to potential opportunities and continued communication with our payer team members. This enables us to secure opportunities on your behalf while brokers and employers are exploring renewal opportunities for their overall health plan expense.

Please don’t hesitate to contact a member of the Hemophilia Alliance Team to assist with your Payer issues. We work for YOU!!

Also in this Issue…

Notes from Heidi and Joe
· Serving Members Where They Are

Alliance Update
· Recognizing the 2021 Wall of Walkers Winners
· Join Us in Salt Lake City!

Legal Update
· Proving the Absence of a Requirement: Use of Funds Derived from the 340B Program for Indigent Care

Notes from the Community
· Recent Articles of Interest

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