Transplant Patients, Physicians and Insurers Begin Dialogue

Meeting Patients' Needs

The National Marrow Donor Program^® (NMDP) Office of Patient Advocacy (OPA) facilitated a roundtable discussion on Sept. 25, 2002, to bring together patients, physicians, government health agencies and health care insurance providers to address the coverage needs of unrelated donor stem cell transplant recipients. "Lives in the Balance: Working Together to Meet the Needs of Patients," held in Washington, D.C., drew representatives from major insurance companies and state Medicaid programs, as well as from several agencies in the U.S. Department of Health and Human Services.

A lack of information about treatment protocols for unrelated donor stem cell transplantation can make decisions about individual patients' coverage slower and more difficult for insurers. Those who attended the meeting came eager to share information that would enable them to be responsive to patients' need for appropriate and timely coverage decisions for unrelated donor stem cell transplantation. The patients, physicians and NMDP representatives who spoke emphasized these key points:

• Early referral and access to transplantation improves outcomes for patients.
• Unrelated donor transplants involve unique clinical processes and costs, such as the search for an unrelated donor, that are not seen in other stem cell transplants.

This event exemplifies the broad strategy of the NMDP in developing new initiatives to help blood stem cell transplant patients. The NMDP's Office of Patient Advocacy is expanding the assistance it offers transplant patients by addressing factors that prevent patients who need a stem cell transplant from receiving therapy. One of the obstacles some transplant patients face is insufficient or delayed financial coverage. The NMDP roundtable was held to address this potential obstacle by:

• Educating insurers about the unique clinical needs of patients undergoing unrelated donor stem cell transplants
• Learning what resources insurers need to help them make good decisions about transplant patients' coverage
• Opening a dialogue between transplant experts, insurers and the NMDP about how to achieve better results for patients

The response to the event was resoundingly positive. "This was a groundbreaking event -- the first of its kind for unrelated donor stem cell transplantation," said Craig Conway, manager of payer policy for the NMDP. "The dialogue opened at this roundtable lays the groundwork for a relationship between insurance executives and transplant experts, with the ultimate goal of improving access and outcomes for patients." The OPA is also pursuing outreach initiatives that address other geographical, cultural, linguistic, racial and/or socioeconomic factors that may cause barriers to transplant.

The OPA offers free case management services to NMDP transplant patients. Patients who have questions about their insurance coverage, or about the transplant and donor search process, their disease and treatment options or other concerns, can contact the OPA for help and information. To contact an OPA case manager, in the United States and Canada call toll free at 1 (888) 999-6743. Outside the United States call 1 (612) 627-8140. For patients who do not speak English, over-the-phone interpretation services are provided.