Payer Update, December 2019

Payer Update

Patient Data: Who Owns It, How Do You Use It, and Why Should You Care?
By Jeff Blake

This has been a very busy year for the Hemophilia Alliance Payer Team, with our primary focus on enhancing awareness of our hemophilia treatment center members with payers and the rollout of the Hemophilia Alliance Network Services (HANS) PPO Agreement.

The payer contracting space is getting more competitive and difficult to manage. We are seeing more payers and insurance companies narrowing their networks for dispensing bleeding disorder products. Most recently, Highmark Blue Cross Blue Shield and Regence Blue Cross Blue Shield announced very narrow networks for dispensing bleeding disorder products and Anthem Blue Cross Blue Shield rolled out their own pharmacy benefit manager, Ingenio Rx. We see these trends continuing in bleeding disorder space and now is the time for our members to band together to compete with payers in specialty pharmacy.

The Payer Team has done an excellent job enhancing awareness of our HTC network with payers. We have developed several key relationships with national brokers and consultants, mid-tier pharmacy benefit managers, third party administrators, large self-insured employers and stop loss/reinsurance carriers. By developing these payer relationships, we have been able to help bring back over 22,000,000 units of clotting factor to the HTCs pharmacy programs. As we have developed these payer relationships, there has been one common message from payers: they want a national HTC network as their solutions for managing bleeding disorders costs. This is an excellent opportunity to meet this payer need through our HANS PPO Agreement and bring more business to your pharmacy programs.

The Alliance Team began the rollout of HANS PPO Agreement to our Board Members in Spring 2019 and to all members this summer. To date, we have twenty-two (22) signed HANS PPO Agreements with members. While this is good start, we need significantly more members to sign the HANS Agreement to finalize the development of our national HTC network. Increasing the number of members that sign the HANS PPO Agreement during the first and second quarters of 2020 will be our number one priority.

We look forward to continuing our efforts and working with you to grow your pharmacy business in 2020.

Also in this Issue…

Notes from Joe
· 2019 Recap

Washington Update

Legal Update
· Legal Team Update – New Contact Information
· Foundations for Grant Compliance: Rules Exist Even When Ignored

Notes from the Community
· Emergency Guides Available

Alliance Update
· Reminder: 2020 340B Program HRSA Grantee Recertification Period Begins in January
· Operations Update
· 2020 Meeting Schedule