When is a Unit not a Unit? 6/7/21

Well, a unit is not a unit when you are measuring human plasma-derived blood factors that are used to treat both Hemophilia A and Von Willebrand disease (VWD). Alphanate®, Humate-P®, and Wilate® are all approved to treat both clotting disorders, but the dosing is different. Clinicians use the labeled Factor VIII amount to calculate dosing regimens in Hemophilia A, but use the Von Willebrand Factor/Ristocetin Cofactor (VWF:RCo) amount per vial when treating Von Willebrand Disease.

Let’s compare these three products including the HCPCS codes as well as current Part B reimbursement from Addendum B (effective 4/1/2021).

As we can see from this comparison, there is a significant difference in the reimbursement because the products have a different VWF:RCo to Factor VIII ratio. 

So, how do we get the billing correct?

Since the ratio of the VWF:RCo to Factor VIII ratio may vary slightly by lot, the best scenario is to provide both actual amounts in the documentation in the patient’s medical record so that billers can verify by product whether it is billed per Factor VIII unit or VWF:RCo unit and adjust the billed units appropriately. 

If Humate-P® is used to treat VWD, but inadvertently billed by the number of Factor VIII units, a significant underpayment will occur. 

If Alphanate® is used to treat Hemophilia A, but inadvertently billed by the VWF:RCo factors, a 20% overpayment will occur.

Since the ratio of VWF:RCo to Factor VIII in Wilate® is approximately 1:1, the risk of billing the units incorrectly is low.

SHOUT-OUTS!

1. Pharmacy IT systems should be set up to clearly distinguish the amounts of Factor VIII and VWF:RCo Factors in each product.

2. Pharmacy should list both the Factor VIII amounts and VWF:RCo amounts in the patient’s medical record so that billers can verify the billed units administered to the patient.

3. Revenue Integrity should develop edits that will stop claims for billed unit review when Alphanate® is used for Von Willebrand disease or Humate-P® is used for Hemophilia A (Factor VIII deficiency).