Payer Update, September 2022

Payer Update

Know Your Patients and Their Insurance
by Jeff Amond, Director Payer Relations

Health Insurance Open Enrollment season has begun. Now is a great time to begin preparing and contacting your patients about their 2023 health insurance to determine if there will be changes that may impact the clinical and pharmacy services you provide.

Tuesday November 1st kicks off the open enrollment period for the ACA marketplace plans, which goes until January 15th in most states (it can be as early as December 15th in some states that run their own exchanges). While there remains a lot of uncertainty in the health insurance market, Congress has enacted some important policies during the last few years that will lower premium and out-of-pocket costs for many people seeking insurance on the ACA marketplaces. For many patients, 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 the deadline in your state.

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

  1. Even though the ACA Open Enrollment Period is over for 2022, 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 or if their household income is below 150% of the federal poverty level (FPL). Please see for complete details.
  2. If your patient qualifies for Medicaid or the Children’s Health Insurance Program (CHIP), they can apply anytime.

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
· Supporting Partners Across the Community

Alliance Update
· Join us for the New HTC Staff Meeting!

Legal Update
· Really, Truly: Only Eligible Patients Can Receive 340B Drugs

Washington Update

Notes from the Community
· HTC Considerations for 2023 DSCSA Requirements

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