Employer Case Studies

Hemophilia and Bleeding Disorders Toolkit

Adherence & Assay/Cost Management: Employer Case Studies

The case studies listed below were conducted by the National Hemophilia Foundation, Hemophilia Alliance, self-funded employers and their insurance consultants/brokers. The results highlight the value and benefits of the Hemophilia Treatment Center (HTC) model for clinical care and integrated HTC pharmacy services, and the benefits of online tools for improving the hemophilia management process.

Case Study #1

A patient with mild hemophilia A and a high-titer inhibitor (more inhibitor present in the blood) was being treated outside of an HTC and was receiving clotting factor from a specialty pharmacy prior to transitioning to an HTC. The patient requested to receive treatment, which included factor VIII and factor VIIa, from the HTC integrated pharmacy after transitioning care.

  • The specialty pharmacy dispensed factor between 5% to 10% above target
  • HTC’s assay management intervention resulted in dispensing at 1% to 4% below target; HTC dispensed factor VIII and factor VIIa at $0.26 and $0.60 lower per unit than the specialty pharmacy

Outcomes:

  • Per-unit price differences resulted in $287,000 per month in cost-savings for the patient’s health plan
  • An additional $460,000 in savings for the plan came from precise management of clotting factor fills and expert medical management

Case Study #2

A patient covered by a self-funded employer was receiving clotting factor through a specialty pharmacy. The development of an inhibitor necessitated a therapeutic switch to a non-factor therapy that was priced higher. At the same time, the patient’s care was transferred to the local HTC to more carefully manage the complications associated with the inhibitor.

Outcomes:

  • Despite the switch to a higher-cost therapy, lower per-unit pricing from the HTC integrated pharmacy model afforded a $1M cost-savings projected over three years and a cost-savings of $1.7M projected over five years
  • Savings were a result of per-unit cost only; additional savings could be realized through HTC-guided assay management and other ancillary services delivered as components of the comprehensive care model

Case Study #3

A 55-year-old patient with hemophilia was part of a pilot group testing an online tool designed to improve patient adherence through real-time tracking and pharmacy notifications. He was taking a long acting prophylactic medication 3x per week. The cost of this medication was $7,600/dose, $91,200/month or more than $1 million/year.

Through the information the patient entered on the app, the pharmacy could see that he was taking this long acting medication more frequently than should be necessary to keep his condition under control. A treatment recommendation was made to switch to short acting therapy. The cost of this new medication was $2,850/dose, $34,200/month or $410,400/year.

Outcomes:

  • Changing the patient to the appropriate therapy saved the payer $684,000/year
  • The health platform used by this patient helped to ensure that the he was on the right dose, at the right frequency, leading to cost savings for the payer