Payer Update, June 2020

Payer Update

By Jeff Blake

The last few years has been very busy for the Payer Team. We have accomplished a lot, but there is so much more that we can do. Through our relationships and marketing efforts and collaboration with HTC members we have been able to bring 30m-40m units of new business to HTCs. This added volume in factor distribution has allowed HTCs to develop and fund new programs, support workforce retention and recruitment and continue to sustain the comprehensive clinical model of care. Revenue from this new business can fund approximately 75 – 100 HTC employees, maintaining and enhancing the care and services provided by HTCs.

To continue our success and bring more business to HTC pharmacy programs will require teamwork. Payers are contacting us daily to discuss potential solutions to better manage and contain the cost of bleeding disorders care. As you know, we tell payers the best solution is to have an integrated model of care that our member HTCs provide that includes medical and pharmacy services. Payers are listening to our message and bringing more potential opportunities to us. We currently have payer opportunities of more than 60m units, which could generate substantial program income to help support HTCs. We plan to share more details of the financial impact of our work on HTC programs on an upcoming webinar.

So, what do we need you to do to bring more business to HTC pharmacy programs? Two things come to mind.

  1. We must be responsive to payers to finalize potential opportunities. We typically have 7 – 10 business days to respond to payer opportunities. How can you help? When a member of the Hemophilia Alliance team contacts you about an opportunity to grow your pharmacy business, please be responsive so we can respond in a timely manner to payers.
  2. Review and sign the Hemophilia Alliance Network Services (HANS) PPO Agreement. We will work with you and your contracting/legal teams to finalize this agreement. This agreement will provide you the opportunity to participate in payer contracts that we have negotiated. We currently have 30 members that have signed the HANS PPO Agreement. To have an effective national network of HTCs and their pharmacy programs we need at least 60 members to sign the HANS PPO Agreement. To have a larger national presence we need at least 80 HTCs to participate.

To learn more about our payer activities, please contact me or a member of the Hemophilia Alliance Team.

Also in this Issue…

Notes from Joe
· Halfway There

Legal Update
· Program Income Rules Still Apply During a Public Health Emergency

Alliance Update

Notes from the Community
· News from the International Community