Payer Update, November 2022

Payer Update

Alternative Funding – an increasing concern
by Jeff Blake, Senior Vice President Payer Relations

We have heard from several member Hemophilia Treatment Centers (HTCs) about a concerning trend with self-insured employer sponsored health plans. This trend named Alternative Funding Model, excludes high-cost drugs specialty drugs from health insurance coverage and redirects access for these drugs to Manufacturer Patient Assistance Programs (PAPs). Historically, PAPs have been used to support patients with short-term gaps in health insurance and are not set up as long-term solutions for patient access to medication.

A recent national survey shows that up to 40% of self-insured employer sponsored health plans have either implemented or are considering implementing Alternative Funding. During this open enrollment season, we have heard from several HTCs that Alternative Funding is impacting more patients.
We have an Alternative Funding Working Group that includes NHF and HFA. Our working group has developed potential legislative and non-legislative strategies to combat this Alternative Funding trend.

We need your help to enhance our efforts to combat Alternative Funding. If you have patients that have encountered this issue or when you do encounter this issue, please contact a member of the Hemophilia Alliance Team with the following information:

  • Bleeding disorder product prescribed
  • Manufacturer Patient Assistance Program
  • Company that contacted you to move your patient to the Manufacturer Patient Assistance Program
  • A copy of the employer sponsored Health Plan Document, Summary Plan Description or Benefits Booklet

Please contact us with any questions or if you would like to discuss Alternative Funding in more detail.

Also in this Issue…

Notes from Joe
· Remembering Patricia Dominic
· Improving Care and Improving Resources

Alliance Board Update
· Alliance Seeking Board Nominations

Alliance Update
· HTC Wall of Walkers 2022 Update
· Operations Update

Washington Update
· Update on the 2022 Midterm Elections

Notes from the Community
· Hemophilia Alliance Foundation: Announcing Project and Patient Assistance Grants!
· United States Hemophilia Treatment Center Network Launches Website

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