Payer Update, December 2022

Payer Update

Recap of Payer Activity
by Jeff Blake, Senior Vice President Payer Relations

2022 was another busy year for the Payer Team. Our focus this year was to increase the number of HTC 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 also focused on gene therapy strategies with our payers, and have developed a gene therapy single case agreement, contract pharmacy and infusion and medical services templates that support the hub and spoke model for gene therapy. We continue to collaborate with NHF and HFA on Copay Accumulator and Maximizer programs, Alternative Funding Programs and other healthcare policies and issues.

We continued to see growth in our HANS PPO Network this year. We now have 42 HTCs participating in our network and we are working with several other HTCs to finalize participation agreements. While this growth has been good, 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 in order to appeal to the larger payers. We continue our efforts to make the HANS PPO Network the network of choice for payers to contract with HTCs and their pharmacy programs in markets where HTCs struggle to gain access to patients for factor dispensation.

During 2022, we have developed and enhanced many payer relationships. We now have six (6) HANS payer contracts with CareSource, Archimedes Rx, AscellaHealth, Security Health Plan, Centivo, and AultCare. 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 five (5) years we have been able to bring back more than 42,000,000 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 70,000,000 units.

We have also been working with State Medicaid Agencies and private payers to cover DDAVP intranasal spray and continue to work on the Skilled Nursing Facility (SNF) Access Act with HTCs and the trade association that supports SNFs.

Additionally, we are seeing an increased interest by Medicaid agencies in establishing a Preferred Drug List (PDL) for factor agents. This is accomplished by the states by “bidding” for supplemental rebates from the manufacturers. If a PDL is established, the PDL frequently allows grandfathering for patients already on an established therapy, but we need to assure that is a consideration in the process. Please watch for activity in this area and let us know if this is occurring in your state.

Thank you for your support in our Payer efforts! We look forward to working with you to make 2023 an even more successful year and working together to grow your pharmacy programs.

Also in this Issue…

Notes from Joe
· Looking Back on 2022

Alliance Board Update
· Welcome New Alliance Board Members!

Alliance Update
· Save the Date for Alliance Meetings for 2023!
· HTC Wall of Walkers 2022 Update
· Flashback to the Fall HTC Member Meeting in October

Legal Update
· Alliance Legal Activities Recap

Washington Update
· 2022 Wrap Up

Notes from the Community
· Hemophilia Alliance Foundation: Announcing Project and Patient Assistance Grants!

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