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Financial & Insurance Issues

Did you know?
An estimated 70% of clotting factor distribution is handled by for-profit homecare companies.
The difference between the acquisition price of factor and its final price can be more than 150%.
Estimated average annual cost for human plasma derived or recombinant factor products is between $50,000 and $100,000.

Great progress has been made in bleeding disorder treatment, HIV treatment, and blood safety. Unfortunately, the financial costs of these advances are equally huge. Management of bleeding disorders places a large financial burden on affected individuals and their families. In fact, clotting factor products are among the most costly treatments in the world, and total annual costs may exceed $100,000. Complications such as major surgery or HIV disease can cause costs to skyrocket even further. Access to the newest, safest, and most effective treatment options depends upon adequate health insurance. Often, insurance policies have limits, called "caps," on certain services or treatments, which can limit access to helpful therapies.

For example, prophylaxis may require about 150,000 units per year for a 65-pound child at a cost of $85,000 per year. This treatment is covered by insurance companies on a case-by-case basis. Those who choose prophylaxis run the risk of reaching their insurance caps much sooner than those who do not. However, while prophylaxis is more expensive in the short term, it may save money in the long run by preventing costly joint replacements and other orthopedic problems. This is one incentive for insurance firms to cover the cost of prophylaxis.

Scientific breakthroughs that have brought recombinant factor products also come at a very high price. The average annual cost of factor products, either recombinant or from human plasma, is estimated at between $50,000 and $100,000—a real barrier to access.

Last, but not least, the hope offered by recent improvements in HIV treatment is offset by the stark reality of their economic cost. These new treatment options, while good news for many, further stretch the already strained financial resources of persons living with both HIV and bleeding disorders.

To learn more about financial issues concerning the bleeding disorders community, refer to the Financial Issues Q&A column in NHF's bi-monthly publication, HemAware. HemAware is a benefit of membership to NHF. To sign up to become a member or to learn more about membership benefits, click here.

The information contained on the NHF web site is provided for your general information only. NHF does not give medical advice or engage in the practice of medicine. NHF under no circumstances recommends particular treatment for specific individuals and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment.
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