Payer Update, June 2019

Payer Update

By Jeff Blake

Over the last two years, the Payer Team has been meeting with a variety of payers (insurance companies, third party administrators, insurance brokers and consultants, pharmacy benefit managers, Medicaid agencies, Medicaid managed care organizations, employer health care coalitions and stop loss/reinsurance carriers). We have been marketing the value of the HTC integrated clinical and pharmacy services model to these payers and we have been successful in bringing pharmacy business back to HTC pharmacy programs. Our goal in 2019 is to be even more successful.

At our 2019 Strategic Planning meeting in January we set a goal to develop and implement a National HTC Centers of Excellence Preferred Provider Network. This network will be managed by Hemophilia Alliance Network Services (HANS), a wholly owned subsidiary of the Hemophilia Alliance. What does this mean for member HTCs?

  1. We will have a “formal” national network of HTCs and their pharmacy programs specifically for clotting factor dispensing. The HTC and HANS will sign a Preferred Provider Network Agreement that will allow HANS to contract with payers that you have not been able to access.
  2. It will allow HANS to respond to payer requests and payer RFPs more quickly and with standardized terms and provisions.
  3. It will bring more pharmacy business back to your program.

Why would a payer want to contract with HANS?

  1. There would be only one contract with HANS and no need to contract with each individual HTC.
  2. There would be common provisions for claims filing, payment, etc.
  3. Better management of bleeding disorder patients with an HTC fully integrated clinical and pharmacy services model of care.

When will HTCs be contacted to learn more about this Preferred Provider Network Agreement?

  1. We have completed a draft of the Agreement and are currently receiving input from our Board Members.
  2. We will be hosting webinars on July 24th and August 15th to provide more details. Look for the email announcing the webinars and registration.
  3. Hemophilia Alliance team members will be contacting our members individually in the late summer and early fall to provide additional information, review the Agreement and sign the Agreement.

We look forward to continuing our efforts to expand the number of patients your pharmacy program can provide service to and working with you on your payer goals.

Also in this Issue…

Notes from Joe
· Checking in, Halfway Through the Year

Legal Update
· To Contract, or Not to Contract – It Depends

Washington Update
· Update on Alliance Advocacy Activities

Notes from the Community
· Update from the Hemophilia Alliance Foundation
· Reminder about 340B Conference

Team Alliance Contact Information

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