Payer Team Update
by Jeff Blake, Senior Vice President of Payer Relations
2021 was another busy year 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 enhance our relationships with the payer community. We’ve had success promoting The Alliance Pharmacy (TAP) as an HTC contract pharmacy option and backstop for our HANS PPO efforts. We assisted 8 HTCs with their billing and reimbursement issues and we recently sent out a Billing & Reimbursement Services Survey to determine how we can expand our services to assist member HTCs. We have also been working on our Disease Management Program and our Cost of Dispensing Survey. We will continue these efforts in 2022.
We have seen excellent growth in our HANS PPO Network this year. We now 40 HTCs participating in our network and we are working with several other HTCs to finalize participation agreements. While this growth has been fabulous, we have a long way to go to have a strong national HANS PPO Network to market to payers. To have a solid national presence we need to have at least 80 HTCs in the HANS PPO Network. We will focus our efforts to make the HANS PPO Network the network of choice for payers to contract with HTCs and their pharmacy programs.
During 2021, we have developed and enhance many payer relationships. We now have four HANS payer contracts with CareSource, Archimedes Rx, AscellaHealth, Security Health Plan and Centivo, and we are very close to finalizing two additional contracts. In addition, 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 four years we have been able to bring back more than 41 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. We are currently working on payer opportunities for our members that account for more than 70 million units.
During 2021, we continued working with HTCs on billing and reimbursement challenges with payers. Today, we have assisted HTC members in collecting over $9 million in outstanding A/R. In addition, we are working on reimbursement of an additional $5.1 million.
We continued the development of a disease management program and Cost of Dispensing Survey. We continued working with Mercer on cost of dispensing data gathering and we planning to complete the Cost of Dispensing analysis in 2022. This is the key first step in finalizing our HTC Disease Management Program.
Finally, we have developed a single case agreement and contract pharmacy template for gene therapy and continue to educate payers on the value of HTCs model of care with integrated pharmacy services. We have also been working with payers to cover DDAVP intranasal spray and we have recently been working on the implementation of the SNF Access Act.
Thank you for your support of our Payer efforts! We look forward to working with you to make 2022 even a more successful year and working together to grow your pharmacy programs.
Also in this Issue…
Notes from Joe
· Looking Back, Planning Ahead
· Not the Old, Not the New, but the Necessary: Legal Review of 2021
· Year in Review
Alliance Board Update
· Update on New and Departing Alliance Board Members
· Operations Team Update
· 2022 Spring Alliance Members Meeting Schedule
Notes from the Community
· Hemophilia Alliance Foundation Announces 2022 Project/Patient Assistance Grant