Payer Update, March 2021

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. Below is a summary of the results of bringing business back to HTC pharmacy programs since 2018.

Total new units 1/1/2018 – 2/28/2021

36,685,000

Current opportunities/potential new units

69,585,000

To continue our success and bring more business to HTC pharmacy programs will require teamwork. Payers are contacting us daily to discuss ways 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 provided by our member HTCs that includes medical and pharmacy services. Payers are listening to our message and bringing more potential opportunities to us. The chart above speaks for itself – in 2 ½ years we have been able to redirect over 36,000,000 units to HTC pharmacy programs and we currently have payer opportunities of almost 70,000,000. If we were able to transition these units to HTC pharmacy programs at a $0.25/unit margin, new pharmacy revenue would be $17,500,000.

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

    1. The Hemophilia Alliance Team is here to help and assist you! Contact a member of the Hemophilia Alliance Team to discuss enhancing and growing your Pharmacy Program.

    2. Stay focused and organized. Gather insurance and prescription data on your patients that do not use your pharmacy program. Our HTC Patient Insurance and Clotting Factor Utilization tool is a tool you can use to remain organized.

    3. 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, be responsive so we can respond in a timely manner to payers.

    4. Review and sign the Hemophilia Alliance Network Services (HANS) PPO Agreement. We will work with you and your contracting/legal teams to finalize the agreement, which provides you the opportunity to participate in payer contracts that we have negotiated. We currently have 35 members that have signed the HANS PPO Agreement. We need at least 60 members to have an effective national network of HTC pharmacy programs, and we need at least 80 to have a larger national presence.

If you have any questions, please contact a member of the Hemophilia Alliance Team.

Also in this Issue…

Notes from Joe
· Imagine That

Legal Update
· Getting Out Your Message without Getting in Hot Water: HTC Marketing and the Grant Rules

Washington Update
· Please Register for the Alliance Virtual Hill Day!

Alliance Update
· Marketing and Operations Update
· Meeting Schedule for 2021

Notes from the Community
· World Federation of Hemophilia: Global Reach. Local Impact.