Payer Update, May/June 2022

Payer Update

Payer Team Update

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 – 4/30/2022 40,438,800
Current opportunities/potential new units 77,812,560

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 may 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. The chart above speaks for itself – in 4 ½ years we have been able to redirect over 40,000,000 units to HTC pharmacy programs and we currently have payer opportunities of almost 78,000,000. These are significant opportunities to grow your HTC pharmacy program business and enhance your revenue to support your HTC.

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 Bleeding Disorder Product Utilization Spreadsheet is a tool you can use to remain organized and focused on growing your pharmacy program.
  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 this agreement. This agreement will provide you the opportunity to participate in payer contracts that we have negotiated. We currently have 40 members that have signed the HANS PPO Agreement. To have an effective national network of HTCs and their pharmacy programs we need at least 80 members to sign the HANS PPO Agreement.

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

Also in this Issue…

Notes from Joe
· Hang in There

Alliance Board Update
· New Board Members

Alliance Update
· Harmony in Hemophilia
· HTC Growth Initiative

Legal Update
· HTCs and Chapters: Partners in Education and Outreach

Washington Update
· Alliance Advocacy Update

Notes from the Community
· Reminder: Announcing the Hemophilia Alliance Foundation 3rd Annual Innovation Grant