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.