Building the Business Case

Hemophilia and Bleeding Disorders Toolkit

Employer Challenges & Opportunities

A work group of employers, focused on better understanding and addressing the challenges and opportunities for members with hemophilia, resulted in the following learnings. Employers shared they:

  • Have limited understanding of hemophilia and how medication costs can be better managed.
  • Lack tools to better manage costs and don’t know where to turn for support building a strategy.
  • Rely almost exclusively on vendor partners to manage hemophilia and other specialty drug spend and may not understand the impact of these practices in increasing costs.
  • Do not routinely receive detailed reports and information on hemophilia claims from PBMs (pharmacy benefit) or carriers (medical benefit).
  • Have no window into waste of high-cost clotting factor in medication delivery and administration; providing excess prophylaxis (clotting factor) can lead to increased employer and patient costs – while increasing revenue for carriers and PBMs.
  • Lack awareness of best-in-class treatment options, including the use of Centers of Excellence (e.g. Hemophilia Treatment Centers).
  • See that costs vary widely from patient to patient
  • Lack treatment alternatives and comparative analysis on efficacy.
  • Need to educate employees and dependents.
  • Are concerned about time demands on employees that care for a dependent with hemophilia and the impact of financial stress on members from high deductible plans and related out-of-pocket spend.
  • Do not have access to quality providers, especially in rural communities; there is little consensus in the provider community on best treatment options.

Working with employers, MBGH will continue to address these challenges and seek opportunities to identify solutions.

Economics of Hemophilia & Addressing Waste

Best Practice Management Approaches

Gathering Meaningful Data

Steps to Take with Vendor Partners

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