Helping You Access the HoG Pharmacy
Horizons in Hemophilia, Fall 2008
By Michelle Fitzwater, Managed Care Contract Specialist
All HoG clients have a choice of where to buy their clotting factor products. Some clients want to use the HoG pharmacy but can’t, due to requirements set by their insurance company. For those clients who would like to use our pharmacy, there are several ways that we can try to help you. Here are just a few:
Meeting with employer
One option is to personally meet with your employer. Usually employers are trying to save costs for the entire company and may not realize how their choice will affect you or your family. You can request a meeting with the appropriate person in Human Resources and simply tell them your story. Let them know you understand the costs of hemophilia and what you are doing to keep costs down, such as utilizing your HTC and the HoG pharmacy.
Negotiating an individual agreement
Individual agreements are often a great compromise for you and the company. We have found that several insurance companies (e.g. Aetna, Cigna) are willing to look at individuals instead of changing the entire group’s plan. This is quite a process and works best with plans that are self-funded. Often we can successfully negotiate a contract at in-network benefit levels even if we are an out-of-network provider. We need sufficient time to make our case to the plan and get appropriate approvals.
Going directly to insurance companies
Our goal is to become an in-network provider for your plan. We have arranged meetings with companies like Blue Cross/Blue Shield, Humana and Cigna to tell them our story. We want to ensure we can continue to provide your factor products and keep your costs down.
Finally, HoG works with the Hemophilia Alliance to promote HTCs and their pharmacy programs across the country. They educate payers on the benefits of HTC pharmacy programs and negotiate for better pricing for factor.
Yes, we are not always successful. There are times where companies are locked into agreements they cannot alter. There are other times where there is a national level contract. Then there are times it is not in your financial best interest to order from us and we will also let you know this.
If you cannot order from us and would like to explore an individual agreement or to speak with your employer please contact Michelle Fitzwater at the HoG office.