Lessons Learned
By Jeff Blake

Over the last two years, the Payer Team has established strong relationships with several national insurance brokers and consultants. These brokers and consultants work with employers, mostly employers with self-insured health plans, to manage their health plan expenditures and design. This month’s newsletter article focuses on “Lessons Learned”.

So, what have we learned over the last two years?

1. Employers are focusing on better managing high costs complex claims – including hemophilia. All eyes are on HTCs, products prescribed and dispensing pharmacy practices.
    
2. Some manufacturers are providing rebates for clotting factor to health plans and PBMs.
    
3. Clotting factor reimbursement from payers is getting more competitive. Our competitors want to grow their business just like our HTC pharmacies. The rates our competitors are charging payers is decreasing, so to remain competitive HTC pharmacy must continue to review their clotting factor reimbursement rates and potentially decrease their rates to remain competitive with payers.
    
4. Self-insured employers and their brokers and consultants are very willing to work with HTCs and their pharmacy programs to reduce the cost of clotting factor. Many times, this requires an individual Letter of Agreement (LOA) between the employer’s health plan and the HTC. The Alliance is providing this service to members at no charge. We are able to leverage the fact that we represent all 107 HTCs. We are also able to bring these opportunities to HTCs that have not started a program, perhaps because they do not see a starting point.
    
5. The payer team typically receives 2 – 4 broker/consultant requests each week. We have experienced and learned several things from these requests.
    
   1. 5% – 10% of the time the HTC and their pharmacy program are already providing the clinical and pharmacy services. No changes are necessary – the employer has the best deal.
       
   2. The remaining 90% – 95% of the time there is an opportunity for the HTC and their pharmacy program to get new business.
       
      1. We are most likely to win the business for the HTC pharmacy when the Hemophilia Alliance and the relevant HTCs can respond to these opportunities quickly – within 5 – 10 business days – and with competitive pricing for clotting factor.
          
      2. When it takes us longer than 2 weeks to respond to employers, brokers/consultants and other payers, their interest in our response has significantly declined and they have moved on to other hot items. Often, we cannot get them re-engaged in our proposal.