Shop for Hemophilia Factor
Edited by Lor777, Eng
Unfortunately, you can't just run to your local pharmacy to buy factor. Why not? Because factor is generally so expensive, few local pharmacies are willing to buy it and wait for your insurance company to reimburse them. Each purchase requires thousands of dollars. If you place a large order and don't pick it up, your poor pharmacist is left with a very expensive inventory that most likely cannot be sold to anyone else in town. Although local pharmacies provide great services, they usually don't have the expertise to properly store, track, and maintain factor inventories. You can't order factor directly from pharmaceutical companies that make it. Factor is a prescription drug and must be dispensed through a licensed pharmacy for your individual use.
Three Options to Order Factor
- 1You can order through the hospital pharmacy.
- 2You can order through a home care company.
- 3You can order through your treatment center, which may be participating in a program called Public Health Service pricing.
Availability, service, and price are key elements to consider when determining which option to choose. Your main focus most likely will be on per-unit price. Always, always ask for the per-unit price of factor!
Frankly speaking, this is usually the worst option, unless your hospital offers Public Health Service pricing. If it does not, and most hospitals do not, your hospital simply sells factor the way it sells any other drug. Hospital pharmacies have an extremely high cost of service to support the hospital structure, and many are not set up to dispense for home care use. Most parents report their hospital charges well over the standard rate of factor. One parent acknowledged that before he became "empowered and informed," he was charged $2.00 per unit for factor--about double the standard cost! Guess where he purchased his factor.
If you are advised to use your hospital, call the hospital first and ask the per-unit price. Another consideration, as you will see, is that in addition to factor, you can often obtain helpful services from your factor provider. These extra services usually are not available from your hospital pharmacy.
Home Care Companies
Consider this scenario: You need factor. You place a phone call, and the next day ten boxes of concentrate are brought to your house, along with knee pads, information about hemophilia, syringes, needles, ace bandages, helmets-in short, just about anything you need, except for maid service. No insurance hassles and no driving.
Is it too good to be true? Not really. Home care companies are specialized service contractors that act as distributors of fact and, often, other drugs or medical services. They purchase huge quantities of factor from pharmaceutical companies and resell it to you. They stock most brands and usually have access to a size or assay that closely mirrors what is required for your infusions. And because all providers bill by the number of units, the closer they get to your size, the better value for you and your lifetime maximums.
Home care companies have licensed pharmacists and nurses on staff available 24 hours a day to answer your questions and assist with your emergency needs. They typically use an overnight delivery service to bring factor to your home, office, or vacation spot. In addition, most home care companies offer many types of "freebies" like pagers, Medic Alert bracelets, ancillaries (all the little medical supplies you need for infusions), bio-hazardous disposal containers with mail back programs--right down to designer Band-Aids and convenient travel packs. Some home care companies will send a nurse to your home to perform or assist in the infusion process. Home care companies allow you to be more independent than you can probably imagine right now, especially when you start home infusions.
Of course, you pay for these services, one way or another. Some home care companies offer all their services as a part of the standard price--remember?--per unit. Other home care companies, allow you to select the services you need, then price accordingly. The more services you order, the higher the per-unit price.
With all these great benefits, how do you choose a company? That's a hard question to answer. First, find out if your insurance company accepts home care companies, If it does, then it may already have a contract with a home care company as part of its in-service provider network. Why do most insurance companies prefer to use a specific, contracted home care company? Your insurance company wants to reduce paperwork and time spent dealing with lots of different companies that provide basically the same service and products. So it accepts bids from home care companies and pick one company--Let's call it the "Concentrates R Us" home care company. Your insurance company will then inform you that you must use Concentrates R US, or you're in big trouble. You can use another home care company, but you may have to pay 20% of the cost, to cover all those insurance people doing their jobs shuffling through all the new paperwork you've brought in from another company. Paying 20% of the cost is not what you want to do. If your insurance plan does not specify a particular home care company, you may be able to choose your own home care provider, preferably one that has experience in or specializes in hemophilia. This will save you time and effort and save them money.
If you Prefer a home care company other than the one contracted by your insurance company, can you convince your insurance company to switch? Sometimes. Remember, the bottom line is per-unit price. If you can show your insurance company that you have found another home care company that charges less per unit, you may be able to convince them that using another home care company is better for everyone--everyone except Concentrates R Us!
Public Health Service Programs (PHS)
Let's say your factor costs $1.00 per unit. Your child uses 500 units for a particular bleed. And let's say he gets factor three times a week because he is on prophylaxis. That's 1,500 units, or $1,500 per week, times 52 weeks in a year, times 10 years. Of course, by age 8 or so, he will have doubled his factor usage because he's bigger. Well, you get the picture.
Now imagine that your per-unit price is $.76. That's a large difference, maybe enough of a difference to give you a few extra years before you reach your insurance cap! Maybe you'll have fewer freebies with this price, but you'll still have your factor when you need it. This is the essence of PHS pricing, a government program that allows federally funded hemophilia treatment centers to purchase factor from the pharmaceutical companies at a significant discount, then sell it to you at a price below that of some home care companies, sometimes even with the convenience of home care.
How to Shop for a Factor Provider
Ask your hospital, home care company, or PHS program these questions before ordering factor.
About my Factor
- What brands of factor concentrate do you provide?
- Will I have a choice of all products?
- Do I have instant availability of product?
- How are products delivered to me?
- How much will I pay per unit of product?
- Do you (the hospital) offer PHS pricing?
- What are your hours of operation?
- Is there a pharmacist available 24 hours a day?
- May I choose the provider of my product?
- Do you (the hospital) offer home care company names, numbers, or brochures?
- Can I use your HTC's services even if I choose a home care company?
- Do you supply ancillaries?
- Do you provide sharps containers?
- How do you dispose of them?
- Do you offer nursing services?
- Do you supply hemophilia support items?
- How much will my insurance cover?
- How do you handle deductibles?
- What happens if I suddenly lose my job and insurance?
- Do you have a reimbursement specialist to help me with insurance problems?
- Are you a provider referred by my insurance company?
Tips Tricks & Warnings
- Even when a company quotes you a price, negotiate.
- Factor can't be put on your charge card.
- Factor doesn't go on sale or have 20% off coupons.
- You can't exchange factor or return it for cash if you make a mistake.
- Everyone wants your business, so use that to your advantage.
- Always know what brand of Factor you use, why you use it, and what price you pay per unit.
Categories : Blood Disorder & Issues
Recent edits by: Lor777