Payer Update, July 2019

Payer Update

TAP, TAP, TAP: How Healthy is your Contract Pharmacy Portfolio?
By Mark Plencner

What can you do to improve your opportunities to serve more of your patients? Everyone understands healthcare is in a season of change. “Disruptive Medicine” seems to be the new buzz phrase, having seemingly overtaken the older and often overused “Paradigm Shift.”

Hemophilia patients and HTCs are experiencing disruptive medicine as never before. Medication breakthroughs such as extended half-life clotting factors (EHLs), bi-specific monoclonal antibodies, and Gene Therapy, once seen as a distant light, are becoming integral parts of hemophilia care or may soon do so. Third party payer and prescription benefit manager business initiatives such as vertical integration, exclusive specialty drug carve-outs, and specialty pharmacy proliferation continue to challenge HTC’s efforts to stay in network, maintain their revenue source and continue to practice integrated care that greatly benefits the hemophilia community.

The Hemophilia Alliance now in its 20th year, has worked thoughtfully and diligently to develop programs and services to help keep your program financially healthy. One important offering has been our association with The Alliance Pharmacy (TAP) as a contract pharmacy option.

We know our member HTCs have an array of pharmacy relationships:

  • HTCs that work exclusively through their in-house pharmacy (which may or may not be registered as a contract pharmacy for the HTC).
  • HTCs that have no in-house pharmacy and work exclusively with one contract pharmacy.
  • HTCs that have several contract pharmacies registered to maximize access to Payer contracts.
  • Some combination of the above.

The Hemophilia Alliance has a strong relationship with TAP. Licensed in 50 states, TAP has wholesale distribution and pharmacy capabilities which can assist your HTC in several ways:

  • Serve as a backup contract pharmacy to support disaster recovery efforts.
  • Provide a source of revenue to start-up programs who are waiting for HTC or pharmacy registration through OPA.
  • Provide a pharmacy option for HTCs that use a Physician Dispense Model and can’t submit a “pharmacy” claim.
  • Dispense clotting factor out of state to patients who are vacationing or away to college in states where your primary contract pharmacy is not licensed.

There is no downside to registering TAP as a contract pharmacy. It costs nothing and will only provide products to patients when asked to do so by the provider, the patient, or both.

If you would like more information about TAP or to discuss contracting with TAP, please contact one of our Hemophilia Alliance Team Members. TAP has developed a generic contract pharmacy template with flexible language that does not commit your HTC to any action but allows for a backup pharmacy option on a moment’s notice. Now is an excellent opportunity to consider TAP as a contract pharmacy.

Also in this Issue…

Notes from Joe
· A Penny for your Thoughts

Alliance Update
· Meet our New Board Members: Laurie Reger and Chris Guelcher

Legal Update
· Recordkeeping and Retention: If You Can’t Prove It; It Didn’t Happen

Notes from the Community
· VWD Connect Foundation Annual Conference Recap

Team Alliance Contact Information

We work for you! Please don’t hesitate to contact any of us with any questions or concerns:

Name Email Phone
Joe Pugliese 215-439-7173
Sean Singh 727-388-7326
Jeff Blake 317-657-5913
Jeff Amond 608-206-3132
Johanna Gray, MPA 202-484-1100
Elizabeth Karan 202-466-8960
Roland P. Lamy, Jr. 603-491-0853
Dr. George L. Oestrich, Pharm.D., MPA 573-230-7075
Ellen Riker 202-484-1100
Mark Plencner 701-318-2910
Michael B. Glomb 202-466-8960
Theresa Parker
Karen Bowe
Joel Bellucci 727-504-0491