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Considerations
Coverage
Life Time Cap
Pre-approval
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ESTABLISHING LIFETIME CAPS
Establishing the lifetime caps (maximum lifetime reimbursement amount) is an important factor when people with hemophilia A or B with inhibitors are planning for surgery.

Know the amount of your insurance lifetime limit. With the help of your HTC or the clotting factor companies there are some options you can try before you reach your cap.
  • Change insurance. Often lifetime caps start over with new insurance.
  • Find out if you can convert the cost of factor therapy from a medical benefit to a pharmacy benefit. Usually drugs reimbursed through your drug plan do not have an impact on lifetime caps.
  • Find out if you can extend the lifetime cap through an exception for patients with chronic disorders.
  • Find out if you can switch to your spouse’s insurance, if you are married.
  • Find out if an assistance program like Patient Services Incorporated (PSI)link arrow 1 can help.
  • Find out if you qualify for Medicaid or for Medicare/Disability.
  • Research the availability of state high-risk pools. These pools provide assistance to patients who do not qualify for insurance but are able to pay premiums.
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