Payer Update, February 2023
Payer Update Call the Alliance Bat Phone! by Jeff Blake, Senior Vice President Member & Community Relations At one of the breakout sessions at our Member Meeting in Nashville this month, we discussed various payer issues that our members encounter. The most common issue discussed was exclusive specialty drug carve outs to commercial specialty pharmacies, […]
Payer Update, January 2023
Payer Update Prepare for the Medicaid PHE Unwinding and Redetermination Process by Jeff Amond, Director Member & Community Relations and George Oestreich, Government Payer Consultant As part of the COVID-19 public health emergency (PHE), state Medicaid programs were not allowed to conduct the typical annual re-determination process for beneficiaries (i.e., state Medicaid programs could not […]
Payer Update, December 2022
Payer Update Recap of Payer Activity by Jeff Blake, Senior Vice President Payer Relations 2022 was another busy year for the Payer Team. Our focus this year was to increase the number of HTC members that participate in our Hemophilia Alliance Network Services (HANS) PPO Network and enhance our relationships with the payer community. We’ve […]
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 […]
Payer Update, October 2022
Payer Update Payer Trends: What You Need to Know by Jeff Blake, Senior Vice President Payer Relations Over the last few years, the Payer Team has established strong relationships with several national insurance brokers and consultants, stop-loss/reinsurance carriers, insurance companies/third party claims administrators and mid-tier pharmacy benefit managers. These payers and advisors work with employers […]
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. […]
Payer Update, August 2022
Payer Update The Payer Relations Communication Highway by Mark Plencner The Payer Team has been working steadfastly over the last four years to return over 40,000,000 units back to the HTCs by contacting and developing relationships with Insurers, Brokers/Consultants, PBMs and TPAs. Through Letters of Agreement and the broader-reaching HANS PPO Agreement, we have shown […]
Payer Update, July 2022
Payer Update Cost of Dispensing Survey: That’s a Wrap! by George L. Oestreich, PharmD, MPA, Government Payer Consultant The payer team has been working with Mercer on the Cost of Dispensing (COD) Survey project for over a year. The project had two phases – Phase 1: Cost of Dispensing Survey to have national and regional […]
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 […]
Payer Update, April 2022
Payer Update Payer Team Update The Payer Team has been working with several HTCs on payer relations and payer contracting issues. The results to date have been very favorable. The Team has helped HTCs retain, add and bring patients back on the HTCs Pharmacy Program. As you can imagine, insurance and utilization data are key […]