I had a nice visit this week from a young man with hemophilia named Tom. Not my son, another nice young man named Tom. I have determined that this Tom, age 26, is the person with hemophilia who now lives closest to me. Even my own son doesn't live with me anymore, so he can be a substitute.

Anyway, the way we met was strange. Last September I decided to rip up the carpet in my basement, which was in dire need of extermination, after years of pets and children had taken their toll. I hired a local flooring company to place lovely tiles that are immune to regurgitated dog food and ground up Doritos. One of the three young men tiling my floor asked me, "Does your son have hemophilia? Because I do." He had seen photos on my basement walls of me with Paul Newman at Camp Hole in the Wall (oh yeah, can't miss that photo), and put two and two together. Here he was, on his knees all day, using really sharp cutting tools to tear up the carpet! We talked for a long time, and I sent him away with all kinds of books and newsletters, and told him to contact me if he ever needed anything. He only lives about three miles away.

So this week Tom did stop by. He quit his job. Tom, Tom! What were you thinking, I wailed, as if he were my own son. Now he has no insurance and no way to pay for factor. No unemployment checks, nothing. Tom also didn't know what to do. He had never really been connected to the community, even though, as I learned, he and my son Tommy had the same nurse as children.

My first thought was, don't get any more factor sent you from your home care company. If his rep decides to send a quick shipment and does not check in first... Tom could be stuck with a bill he could never afford. Did he contact his home care company immediately to stop any more shipments? No. I made him promise to call that afternoon, so he will not accidentally get stuck with a big shipment that would eventually ruin his credit rating.

Did he tell his HTC? No. That would be his next call. Does he know what product he uses? Yes. And thankfully, his home care company enrolled him in a coupon program, so he has lots of coupons. Cash them in! He should get some free factor.

After talking, Tom saw his error. A person with hemophilia if at all possible should never just quit their job. So much preparation needs to be done first. At least we have lots of help in this community. From ACCESS to PSI to the Hemophilia Hotline, Tom has many resources to contact for advise and help. And as he walked out the door (I couldn't tell if he was happy or sorry he came), I handed him this issue of PEN--"What To Do When You Lose Your Insurance." The forlorn young man on the front could have been him.

Guys with hemophilia--don't quit your day job. Tough it out for the sake of your health. Or I am coming to lecture you, too.

Labels: Insurance, PEN, quitting your job

The ongoing insurance cost-cutting has impacted hemophilia deeply, particularly since we are flashing beacon on payers' radar. One of the most prominent impacts has been forced homecare switching. Reactions by families include irritation at being switched without forewarning; anger at being switched without any say in the matter; and fear at being switched to a company that has no experience with hemophila.

Read the current issue of PEN, which delves deeply into what is happening, why, and how this could impact you. We interview 17 patients and opinion leaders to see how forced switching is impacting lives. What we do know is this: forced switching is not something that can easily be reversed, and it is definitely a cost-cutting tactic that is here to stay. Tims are changing--read PEN to learn about all the changes and how to adapt while best protecting your loved ones with bleeding disorders. If you are not on our mailing list, please contact us at 978-352-7657 to sign up! It's free to patients, HTCs and nonpofits.

Labels: homecare companies, PEN

Happy new year! We're off to an exciting but challenging start to this year in the bleeding disorder community. Witness what is happening right now, that should have you sitting bolt upright: a hostile takeover bid for Caremark. Do you use Caremark as your homecare company? Keep your eye on what is happening.

A year ago, my newsletter PEN predicted that specialty pharmacies would continue to merge as the home care industry faced unprecedented change while battling the "coming storm" in the insurance industry. Cost-cutting methods by payers are forcing the industry to rethink how it does business; and mergers provide ways to gain power, market share and possibly lower prices.

We've seen a tremendous number of mergers and acquisitions, but nothing on the scale of what is happening now. Express Scripts, one of the nation's top pharmacy benefit managers (PBMs), has launched a hostile bid for Caremark, one of the largest factor providers, and also a PBM. The surprise $26 billion bid came in December.

In "Taking Center Stage" (PEN, May 2005), PEN explained that PBMs are business middlemen hired by employers and insurers to negotiate better prices from drug manufacturers and retailers. They encourage employees to use lower-priced generic drugs and less expensive mail-order pharmacies. PBMs are hired to save employers money by managing healthcare contracts and costs. But in the current wave of mergers, PBMs are emerging with great power, and can exert strong influence over pricing, especially for biological products like factor.

The Los Angeles Times predicts that the Express Script/Caremark combined company will control about 30% of the total PBM market, with $49 billion a year in revenue. That's compared to its next biggest rival, Medco (which owns Hemophilia Health Services), with $38 billion a year in revenue. The LA Times also notes that not everyone is confident that more consolidation is good. There's no guarantee that this merger will eventually pass along savings to employers and employees, including those with hemophilia. It's true that the merged company will be the most powerful in factor distribution. Smaller, independent factor providers--a traditional and important part of the bleeding disorders community--face troubled times ahead as they play David to the industries' newly-created Goliaths.


For more information, see "Express Scripts tops CVS in hostile bid for Caremark Rx." Daniel Costello, Los Angeles Times, December 19, 2006, and visit archived article at www.kelleycom.com/archives.html.

Labels: Caremark, HHS, PBMs, PEN