“The January Blues”
by the Member and Community Relations Team
As you painfully know, every January payers shift the landscape and HTCs experience many obstacles to their pharmacy program. Benefits, formularies, prior authorizations, and prior authorization processes change. HTCs may lose patients to commercial specialty pharmacies and the narrowing of networks. We know that Alternative Funding Programs are on the rise and many patients have had a Copay-Accumulator or Copay Maximizer Program added to their benefits. The point being, January can give every HTC “the Blues” if they don’t have a plan in place to address these potential changes affecting their patients. We know every HTC has experienced this at some point. If you’re running into any of these issues, please reach out to your primary contact within the Member and Community Relations Team.
Here are examples of some information we may need:
- Copy of insurance card
- Identifies who the insurance company is and if it is a fully funded or self-funded plan.
- Have you received an official denial?
- If so, what is the reason for the denial? Include a copy of the letter if available.
- Diagnosis and severity?
- What is the product and dosage?
If an issue is affecting your HTC, it may be affecting others. By sharing your experience, we can help each other.
Also in this Issue…
· Welcome 2024
Advocacy Update
· Hemophilia Alliance 2024 Hill Day – The United Voices of Our Community
Washington Update
· Proposed Rule on Affordable Care Act Provisions Published
· Congress Puts Off Funding Bills Until March
· CMS Publishes Prior Authorization Final Rule
Legal Update
· Legal Team Update: Beware! Scammers Steal Funds from Department of Health and Human Services (HHS) Grant Recipients
Alliance Update
· Viva Engage! Hemophilia Alliance Virtual Networking Platform
· 2024 Meeting Schedules
Notes from the Community
· WFH 2024 World Congress taking place this April