Hemophilia is an inherited bleeding disorder that can lead to spontaneous and excessive bleeding especially following injury or surgery. There are several different types of Hemophilia. Treatment includes replacing missing factors in the clotting process. Prescription treatments cost more than $2 million per year in many cases. These claims are a tremendous liability for a self-funded health plan. Collaboration and aggressive co-management of these high costs are critical to the successful management of these claims.

Tokio Marine HCC – Stop Loss Group can assist in managing catastrophic high dollar claims resulting from outpatient Hemophilia treatment costs. Our team of nurses and experienced staff collaborate with third party administrators, case managers, and brokers to identify situations for potential cost containment. As a value added service, Tokio Marine HCC will cover a percentage of vendor fees up to an annual maximum. For details, please contact one of our Clinical Nurse Managers.*

Hemophilia Cost Containment Solutions

To reduce the costs of treatment for Hemophilia, Tokio Marine HCC works with our clients to access favorable contracted pricing and special rate programs. We have partnered with Lifetrac, a vendor, to secure preferred rates for Factor VIIA, Factor VIII, Factor IX, and other high cost prescriptions related to the outpatient treatment of hemophilia. In addition, our specialty claims nurses can assist with review of high dollar inpatient claims for potential negotiations or other reductions. Our specialty nurses can also assist the health plan in identifying a center with 340-B pricing (a federal funded pricing program for hemophilia factor).

If you have identified Hemophilia claims such as these, please contact:

Michael Watson, Clinical Nurse Manager
Phone: (770) 693-6408
Email: mwatson@tmhcc.com

Patricia Harrington, Clinical Nurse Manager
Phone: (770) 693-6578
Email: pharrington@tmhcc.com

*The success of reducing costs in these cases depends largely on early notification and cooperation in reviewing these claims before any payment is made.