New Alliance Initiatives Launching to Help Members Face Payer Challenges - By Pam Betz From the new exchanges born out of the ACA to the merger or takeover of specialty pharmacies and PBMs the landscape of healthcare is changing. The Hemophilia Alliance is working to help its members navigate these changes. At its strategic planning meeting held in February 2014, the Alliance board unanimously agreed that HTCs are increasingly being excluded from insurance networks and a focused effort is needed to reverse that trend. The board directed that several initiatives be undertaken to assist HTCs with this growing problem. First, the Alliance is developing a toolkit for HTCs to use for payer challenges. It will include a checklist of steps to attempt when you get the call that you can no longer serve a patient on your 340B factor program and a power point presentation that you can use or customize to present to employers, insurance companies and PBMs to make your story heard. It will emphasize the comprehensive care model, the cost savings opportunities, and the outcomes of the high quality disease management that only the HTC model can offer. If there are particular resources that you would find useful, please let us know. Second, the board agreed to launch a regional insurance initiative. We are starting with HTCs in several states to capture de-identified information on patients that they have lost the ability to serve or those patients who would like to utilize the HTC 340B factor program but cannot due to insurance mandating the use of other specialty pharmacies. We have analyzed the initial data, which are providing insight into the insurance trends impacting the HTCs in this region. It is clear that self-funded employer plans that utilize PBMs, brokers and PSAOs to develop benefit packages that they offer to their employees don’t understand and appreciate what HTCs can offer. We are starting to reach out to these organizations so that we can educate them about hemophilia and the comprehensive care model available only through the HTC network. The consultants of The Hemophilia Alliance will work together and with NHF as appropriate on these initiatives. We welcome your comments regarding issues that you may be experiencing at your HTC. Watch the newsletter for progress updates and links to the tools under development.
Posted on: Tue, 27 May 2014 09:38:39 +0000
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