Payer Update, December 2020

Payer Update

Year in Review
By Jeff Blake

This year has been very busy for the Payer Team. Our focus this year was to increase the number of Hemophilia Treatment Center members that participate in our Hemophilia Alliance Network Services (HANS) PPO Network and to continue our efforts to develop and enhance relationships with the payer community. During the second half of the year, we began our rollout of our new billing and reimbursement services. We have also been working on the development of a Disease Management Program to offer to state Medicaid Agencies and private insurers.

We have seen excellent growth in our HANS PPO Network this year. At the end of 2019, we had fewer than 20 member HTCs participating in the HANS PPO Network and we now have 35 participating HTCs. While this growth has been fabulous, we have a long way to go to have the 80 participating HTCs necessary to comprise a national HANS PPO Network. We will continue to focus our efforts on recruiting HTCs to make the HANS PPO Network a strong national network.

During 2020, we have developed and enhanced many payer relationships. We now have four (4) HANS payer contracts with CareSource, Archimedes Rx, AscellaHealth and Security Health Plan. In addition to these payer contracts, we continue to increase the number of insurance brokers and consultants, insurers, mid-tier PBMs, third party claims administrators, self-funded employer health plans and reinsurance/stop loss carriers we work with. Over the last three (3) years we have been able to bring back more than 36 million bleeding disorder product units back to the HTC pharmacy programs and we want to work with our members to significantly increase this number over the next few years.

In August, we rolled out our new billing and reimbursement services. Our initial focus has been working with our members on specific billing and reimbursement issues they have encountered with payers. Today, we are assisting our members with over $3 million of billing and reimbursement issues with payers. In 2021, we plan to rollout additional reimbursement and billing services to support your pharmacy programs.

This year we continued the development of a disease management program for state Medicaid Agencies and private insurers. We are working with a national consulting firm to develop and pilot this program with at least one (1) state Medicaid Agency. The final development of the disease management program will require gathering some key data elements from our members. During the first six (6) months of 2021, we will be working with members on a survey about costs of dispensing and the cost of providing all the clinical and care coordination services you provide to your bleeding disorder patients.

Thank you for your support of our Payer efforts! We look forward to working with you to make 2021 a more successful year and continuing to work together to grow your pharmacy programs.

Also in this Issue…

Notes from Joe
· Looking Back, Planning Ahead

Legal Update
· Update and Year in Review

Washington Update
· Year in Review

Alliance Update
· Operations Update
· 2021 Meeting Schedule