Payer Update, October 2019

Know Your Patients and Their Insurance

Health Insurance Open Enrollment season has begun. Now is a great time to begin preparing and contacting your patients about their 2020 health insurance to determine if there will be changes that may impact the clinical and pharmacy services you provide.

November 1st kicks off the open enrollment period for the ACA marketplace plans, which goes until December 15th. Given all the uncertainty in the health insurance market, some plans’ premiums are increasing. Despite that, people may be able to enroll in more generous or less expensive coverage than last year depending on their state and individual financial situation. It will pay to shop around. Given the time frame to enroll and the premium changes, we encourage you to contact your patients enrolled on ACA plans to be sure that they reenroll in coverage before December 15.

Some additional items to consider about the ACA for your patients:

  1. Even though the ACA Open Enrollment Period is over for 2019, your patient can still enroll in or change a Health Insurance Marketplace plan if they have a life event that qualifies them for a Special Enrollment Period. Please see for complete details.
  2. If your patient qualifies for Medicaid or the Children’s Health Insurance Program (CHIP), they can apply anytime.
  3. Depending on their state, the ACA Marketplace may show both “regular” ACA-compliant plans along with short-term, limited duration plans that do not have to follow the ACA rules (i.e., short-term plans don’t have to cover prescription drugs and most have low lifetime and annual caps). Please remind your patients that they need to look closely at the coverage rules for any plan they are considering.

Some additional items to consider for your HTC include:

  1. Do you have a solid process in place to track your patients’ insurance?
  2. Do you know if their insurance is a fully insured or self-insured plan?
  3. Do you know if your Pharmacy Program can dispense clotting factor?
  4. Do you need the support and assistance from the Hemophilia Alliance to enhance your Pharmacy Program and insurance contracting efforts?

The Alliance Team is here to help. We have developed a Patient Insurance Tracking Spreadsheet and Insurance Questionnaire to assist in your efforts. Please contact one of the Alliance Team Members to discuss how we can assist you in your Payer Relations and Insurance Contracting efforts and always remember We Work for You!

Also in this Issue…

Notes from Joe
· The More Things Change . . .

Alliance Update
· Our Library Has a Little of Everything
· Alliance Seeking Board Nominations

Notes from the Community
· NHF’s Bleeding Disorders Conference Brings the Community Together
· HTRS Announces Second Research Colloquium
· Update from the Hemophilia Alliance Foundation

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
Karen Bowe 717-571-0266
Johanna Gray, MPA 703-304-8111
Kiet Huynh 917-362-1382
Elizabeth Karan 612-202-3240
Kimberly W. Lackman 813-400-6710
Roland P. Lamy, Jr. 603-491-0853
Dr. George L. Oestrich, Pharm.D., MPA 573-230-7075
Ellen Riker 202-257-6670
Mark Plencner 701-318-2910
Michael B. Glomb 202-466-8960
Theresa Parker 727-688-2568
Joel Bellucci 727-504-0491