Benefit Plan Design Approaches

Hemophilia and Bleeding Disorders Toolkit

Necessary hemophilia-related costs usually can’t be reduced, but unnecessary costs can be avoided and cost trends contained.

It is important to understand your current benefit design and how it relates to hemophilia. Removing barriers and obstacles in the path of optimal hemophilia treatment will ultimately lead to better patient outcomes and avoidance of unnecessary costs for employers.

You think hemophilia doesn’t apply to your plan and you don’t have to pay attention, but what happens when it does? You need to be ready to put plan design changes in place now. Being proactive means less disruption.

Using Plan Design to Improve Outcomes

Carve Out & Contract Standardization

Patient Financial Assistance

What do employers look for to determine the value of best-in-class therapies?

  • I don’t believe rebates should determine where we cover a benefit – it should be efficacy. Any study that shows efficacy is important and I use those to talk to my health plan or PBM to have the right information, and then I fight back when I have to.
  • With some of the game changing therapies, we talk directly to the manufacturer to better understand their data and evidence and how the science stacks up compared to others.
  • I look at randomized controlled trials, double-blinded studies and peer-reviewed studies that focus on efficacy.
  • We talk with our health plans, PBMs and consultants to understand how they have evaluated certain new-to-market drugs from a clinical standpoint. It all goes back to data and evidence made available through the different stakeholders.
  • I look to what the prescribing community has to say, especially with new therapies. I am interested in what medical associations, large hospital groups and prescribers are doing and how they are reacting when a new therapy comes out.

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