Payer Update, Hill Day 2020

Payer Update

HANS PPO Agreement: 32 signed, 75 to go! 
By Jeff Blake

As many of you know we have been working the last 12 months to develop and implement the Hemophilia Alliance Network Services (HANS) HTC PPO Network.  We now have 32 signed PPO agreements with our HTC members, and we are working with several other members who are running the agreement through their process.  Imagine if all our member HTCs signed the agreement: we could offer the very best network of HTCs to payers.  Our payer team has made an initial outreach to every HTC and we will continue to follow up; at this exciting time, please consider participation so we may continue to bring new volume to your center.

We now have 3 HANS agreements with payers that are opportunities for members who have signed up to be part of the PPO Network.  These agreements have brought back millions of units to participating HTCs pharmacy programs, which has strengthened their sustainability.  We are working on more than 40 additional payer opportunities right now, which we hope will also develop into opportunities for our members.  As we continue to work with HTCs on the PPO Agreement, we have received several common questions comments about the HANS PPO Agreement, which are addressed below.  

A couple members were concerned that HANS will compete with their current payer contracts.  I will be clear: HANS has no interest in competing with your current payer contracts; our only goal is to help members increase their pharmacy business to support their HTCs.  By requiring data at the beginning of negotiations, we are able to minimize any conflicts with existing HTC agreements.  We seek to bring new volume to your HTCs, helping to capture dispensations to patients you may already treat clinically.  To provide a recent example: a regional payer asked HANS to respond to a Request for Proposal (RFP) for bleeding disorders pharmacy services.  During our discussions, we learned that the payer had also contacted individual HTCs in the region about the RFP.  We asked if the payer preferred to pursue one contract with HANS or to work with their local HTCs directly.  This payer wanted to work directly with the HTCs, so we dropped out and notified the HTCs that HANS can support their efforts.  We also told the regional payer that HANS can support any situations if they have a covered member located out of their region.  Hopefully, this recent situation highlights our efforts to support our members and not compete with current payer contracts. 

We have also heard concerns that the HANS PPO minimum rate structure is lower than the HTC’s usual and customary rates.  These rates are included to create a baseline for the lowest possible rate HANS would agree with a payer.  To date, all our payer agreements and individual Letters of Agreements (LOAs) have been above the HANS minimum rate structure.  Also, we continue to review market conditions to monitor the minimum rate structure and will amend the minimum rates, as necessary.

We recently received positive comments about the opt-in provision in the HANS PPO Agreement.  Several HTCs like this feature, since HTCs are not required to participate in a HANS Payer Agreement, but rather can review the terms of any opportunity and determine if they want to participate.

The Hemophilia Alliance Team is excited about our efforts with payers to support our members and we look forward to working with more member HTCs to expand our HANS efforts to help you grow your pharmacy business to support your HTCs operations and programs.

Please contact a member of the Hemophilia Alliance Team to learn more about HANS or how we can assist in solving your payer issues.

Also in this Issue…

Notes from Joe
· Advocacy Matters!

Legal Update
· 340B Program Attacks: What You Need to Know and How to Respond

Washington Update

Alliance Update

Notes from the Community
· Hemophilia Alliance Foundation Offers Additional Grant Opportunities for COVID-19 Patient Assistance