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B Together: The Coalition for Hemophilia B Symposium

By Michelle Stielper and Tina Mcmullen


It is always good to “B” together; however, NOTHING has felt as sweet as The 2022 Coalition for Hemophilia B Annual Symposium. After two years of virtual meetings, bingo games, and On the Road meetings, we all came together at the Renaissance Orlando at SeaWorld May 19-22nd.

Many precautions were implemented by the fabulous and exceptionally hardworking Coalition staff to help keep us healthy—COVID-19 tests, masks, and red, yellow or green lanyards indicating each person’s interaction level of comfort. However, this meeting was not short of tapping elbows, high fives, or welcomed hugs. It was an event filled with love and gratitude simply to be together.


As always, the educational sessions and breakouts did not disappoint—men’s and women’s gatherings, breakouts to harness the power of togetherness and strength in adversity, and sessions about being brave and using your voice and story to advocate for yourself, your child, or future generations within the bleeding disorders community. 

There were excellent inspirational speeches by Zander Massar, Debbie de la Riva, Natalie Sayer and Kelly Gonzalez, to name a few. There was also an informative presentation by Dr. Sidonio focused on understanding Factor IX’s role in the body. Hope Woodcock-Ross and Dr. Mike Zolotnisky led an infusion class combined with KT tape strategies for protecting joints. The list goes on with meaningful, impactful, and much needed educational programming.

The BioMatrix booth was buzzing all meeting long with a steady stream of contestants lining up for Jeo-Parody, our Jeopardy-inspired game. With the incredibly talented gameshow host, Shelby Smoak, participants answered questions to enter a drawing for an awesome cooking-themed gift basket filled with our BioMatrix favorite family cookbook and bunches of useful kitchen doodads.

For “fun points” and just because, we made it a friendly competition between the ladies and gents.

Each day featured a different themed game board, and we soon found out just how many of our hemophilia B families are diehard Jeopardy fans! Smiles, laughs, and cheers erupted all around as game points were added to the scoreboard. In the end, the gents were close, but the ladies won at the final hour. Girl Power! Congratulations to all our players and especially to the winner of our gift basket.

The Symposium’s final night event is always an evening to remember, but The Bleeders (essentially the Coalition B house band) really outdid themselves this year. Moved indoors due to rain, our own Doc of Rock Shelby Smoak and the whole band brought the atrium of the Renaissance hotel down! No one gets the party going like our bleeder band! Many thanks, guys, for always giving us great tunes to sing along to while we wear out our dancing shoes. When does the album drop?! With top notch music, the party went strong well into the night!

This was truly the greatest Symposium meeting in years, well, because it has been years! We never need a reminder to know how impressive our B community is, but it sure was amazing to “B” together again! Here’s to a great 2022, and we are already looking forward to what the Coalition has in store for Symposium 2023!


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Medical Debt and Your Credit Report

By Shelby Smoak, Ph.D.


Almost 137 million Americans have medical debt, and it is the leading cause of bankruptcy.1 Since the cost of treatment is high and is forever, persons with a chronic illness like a bleeding disorder are certainly at risk of accruing unwanted debt. One study estimated the current cost of factor therapy alone at between $460,000 and $600,000, and with insurance and high deductible plans, year in/year out, the financial burden on patients and families can overwhelm.2

Moreover, even if a person’s bleeding disorder is “managed,” one bad bleed can create a tsunami of costs, especially if it impedes one’s ability to work; thus, while costs go up, income goes down. What can one do when faced with seemingly insurmountable medical costs?


What can you do if you have unpaid medical debt?

  • Obtain copies of medical bills, and review them for any errors.

  • Negotiate the bill with your provider. Be honest, and let them know your financial situation. Many providers have programs to assist patients.

  • Assure that some amount is being paid on the bill. Do not leave the bill unpaid.

  • Get an estimate of medical costs beforehand if you are able.


What can you do if you receive a high medical bill that you cannot pay?

  • Ask the hospital or provider if you qualify for their financial assistance policy, sometimes known as charity care.

  • Ask if you were charged the “chargemaster rate,” and if so, request the lower rate given for insurers and Medicare.

  • Have the provider go through and explain all charges to avoid mistakes.

  • Work out a payment plan.

  • File an appeal with your insurance company if a service was denied, and you think it should have been covered.


How will medical debt impact my credit score?

  • Beginning July 1, 2022, medical debt that has been paid will no longer be included on consumer credit reports according to a recent agreement between the three top credit reporting agencies—Equifax, TransUnion, and Experian.

  • Medical debt will not be reported on consumer credit reports until it has remained unpaid for a year. Currently, medical debt is reported at six months and is reported whether paid or unpaid.

  • Medical debt under $500 will not be reported.


Should I consider bankruptcy?

  • The legal term “medical bankruptcy” does not exist. There is only “bankruptcy.”

  • Depending on income and other factors, Chapter 7 or Chapter 13 would need to be filed.

    • In Chapter 7, a liquidation bankruptcy, assets are used to repay debts, and debt is discharged after an asset liquidation. It is often less expensive and faster but can result in property loss. Chapter 7 impacts a credit score for ten years.

    • In Chapter 13, debt is restructured and a 3–5-year repayment plan is established. Chapter 13 impacts a credit score for seven years.

  • Consider alternatives as many creditors are more willing to work with medical debt.


As difficult as medical debt can be, emotionally and financially, there are services and programs available to help patients navigate those crushing expenses. The move by the three credit agencies is expected to remove approximately 70% of medical debt from consumer credit reports. The key takeaway is that if you do have unpaid medical debt, work with the provider to begin paying some amount towards it to keep your credit score in good standing.


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References

  1. “Medical Debts and Collections.” Debt.org

  2. “The High Price of Hemophilia.” ASH Clinical News. 1 Feb. 2020. https://www.ashclinicalnews.org/spotlight/feature-articles/high-price-hemophilia/

The Gift of Volunteering

By Milybet Cepeda, EdD


“Volunteering is a gift for you. It can be the best thing you do for your community and for yourself.”


Since high school, I have volunteered for various causes—food drives and events for diabetes and cancer, to name a few. When my son, Omar, was born in 2004, I promised myself I would teach him the importance of giving back. Having participated in the AIDS Walk New York since 1998, it was soon to be Omar’s first walk in 2005 when he was just 10 months old.

At birth, Omar was diagnosed with severe hemophilia A, giving me a whole new cause in which to be involved. We have since participated in many bleeding disorders events.

We moved from New Jersey to Florida in 2007 and were soon involved with the local hemophilia organizations. In 2015, we moved back to New Jersey and continue our commitment to our local organizations. I have made connections and cultivated many friendships within the bleeding disorders community through these groups and events. These excellent organizations helped my family tremendously with advocacy, education, and emotional support. In turn as a family, we do what we can to help raise funds so they can continue their mission of providing programs and services to enhance the quality of life in the bleeding disorders community.

In addition to participating in and serving on fundraising walk and educational committees, I have been a guest speaker and have emceed while Omar and my husband, Harry, as deejays, get the crowds moving to awesome music! We also gather our friends and family members to join us! We have been able to raise funds in some unique ways—hosting a yard sale, raffling a handmade quilt featuring the school’s name at my 20th high school reunion, and my niece donating a portion of her sweet 15 birthday gift money to our local chapter. All these little things can make a difference!

People volunteer for a variety of reasons. It may be to support a cause they are passionate about, to make new friends, for something to do while the kids are at school, or to fill the hours for those who are empty-nesters or retired. We often volunteer to assist groups or individuals who may need the help or to impart our been-there, done-that experiences. We volunteer because we know it makes a difference in the world in which we live.

Volunteering can have enormous and surprising benefits for you as well. It can provide a sense of achievement and enrichment. It increases self-confidence, offers a sense of community and gives you something to be proud of. It can teach new skills and expand knowledge, help discover hidden talents, and open doors of opportunity by expanding your resume and perhaps increasing career opportunities. 

For me, there are mental health benefits in getting involved. When I donate my time and connect with others, I am less likely to feel sad or lonely. It provides me with a sense of purpose and helps me build friendships and a network of people I can rely on. Volunteering serves as a stress reducer and has helped me deal better with painful struggles. It fills my soul and leaves me with a fuzzy feeling in my heart. Volunteering makes me smile.

There are many ways to volunteer within your community. If you’re unable to volunteer in person, for example, because of distance, there are other ways to contribute. Serve on planning committees, organize a walk team, write articles for an organization as a way to share your experiences and knowledge, be a contact for a newly diagnosed family, participate in advocacy projects such as State and Washington Days, volunteer as a counselor at a bleeding disorders camp, or help out at a fundraising golf tournament. There are countless ways to make the most of your time while giving to a worthwhile cause!

Get started by contacting a local or national bleeding disorders chapter, and find out what you can do to help. Most are eager to engage volunteers. Seek opportunities that align with your values and experience. Life can be more positive, satisfying, social, and fun when you volunteer!


I Volunteer for:

  • For my son, Omar, who is destined for greatness. I love you, Papo!

  • For those who choose to care, cheer on, and be part of my son’s life

  • For my dear father who passed away due to hemophilia complications

  • For me... I have hemophilia too

  • For parents whose child was recently diagnosed

  • To help boost hemophilia research and advocacy 

  • For the bleeding disorders community because they are my family

  • To never forget how far we’ve come with resources, effective treatments, and blood safety

  • For the survivors

  • Because it takes a village to support all children with a chronic health condition

  • To raise awareness and educate others to better understand bleeding disorders


About Milybet Montijo-Cepeda, EdD

Dr. Milybet Montijo-Cepeda holds a Doctorate in Education specializing in Organizational Leadership from Nova Southeastern University of South Florida. Her dissertation was on: Resilience Among Parents of Children with Hemophilia. Dr. Cepeda has served as a special education teacher for more than 21 years, a motivational speaker, a meditation and mindfulness instructor, and a Walk emcee. Milybet resides in New Jersey with her family.


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Psoriasis—Types, Symptoms, and Treatment Options



Psoriasis is a chronic autoimmune skin condition affecting nearly 7.5 million people in the United States.1 Symptoms include thick patches of red, scaly skin, often leading to cracking and bleeding. Although psoriasis affects all age groups, it’s most commonly seen in adults ages 45 to 64.1 Types of psoriasis include plaque psoriasis, psoriatic arthritis, inverse psoriasis, guttate psoriasis, nail psoriasis, pustular psoriasis, and erythrodermic psoriasis.


Psoriasis Symptoms

Signs and symptoms vary based on the type of psoriasis and the individual:2

Plaque psoriasis (the most common)

  • Rash appears as dry, itchy, raised skin patches (plaques) covered with scales

  • There may be a few plaques or many

  • Plaques typically appear on the elbows, knees, lower back, and/or scalp

  • Plaque color varies based on skin color

  • Healing may bring temporary skin color change (post inflammatory hyperpigmentation)

Psoriatic arthritis

  • Symptoms appear as joint pain, stiffness, and/or swelling

  • These symptoms may flare and subside

  • Stiffness is typically in the morning

Inverse psoriasis

  • Primarily affects the skin folds of the groin, buttocks, and breasts

  • Rash appears as smooth patches of inflamed skin, worsening with friction and sweating

  • May be triggered by fungal infections

Guttate psoriasis

  • Primarily affects young adults and children

  • Usually triggered by a bacterial infection like strep throat

  • Rash appears as small, drop-shaped, scaling spots on the trunk, arms and/or legs

Nail psoriasis (fingernails and toenails)

  • Symptoms appear as pitting (tiny dents in nails), abnormal nail growth, and/or discoloration of nail(s)

  • Nails can also loosen and separate from the nail bed (onycholysis)

Pustular psoriasis (rare)

  • Appears as clearly defined pus-filled blisters

  • Can occur widespread on the body or in smaller areas on the palms or soles

Erythrodermic psoriasis (the least common type)

  • Appears as a peeling rash that can itch or burn intensely

  • Can cover the entire body

  • Can be short-lived (acute) or long-term (chronic)


Treatment Options

While treatment for psoriasis depends on the type and severity of the patient’s case, the goal should always be to find a treatment that works best with the fewest side effects. Treatment for mild symptoms may include ointments, creams, and ultraviolet light therapy. For more severe cases, biologic injections of IG may be needed.


How BioMatrix Supports Psoriasis Patients

By collaborating with the patient and physician, BioMatrix can help reduce moderate to severe psoriasis symptoms and flare ups with the fewest side effects possible. With a full range of treatment options, our pharmacists and support staff help patients stay on track while monitoring progress and side effects. 

Learn more about how we help patients achieve clear skin.


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Video: The 411 on 504's (2022)

For caregivers of children with a chronic health condition, it is important to understand legal rights for academic accommodations.

Join BioMatrix as we host a webinar focused on facilitating academic success for children with special healthcare needs.

Overview: This program is designed to empower parents to understand their child’s rights for accommodations in the academic setting. The presentation provides information and resources to design and implement effective 504 plans, transition between grades, schools, and alternate academic settings during the time of COVID-19. Presented by a mother and educator with children who have multiple chronic health conditions, this presentation draws on research, resources, and personal experience.

Key Learning Objectives:

  • Understand qualifying conditions and rights for academic accommodations

  • Understand the components of a 504 plan

  • Learn how to effectively set-up, implement, utilize, and preserve a 504 plan

  • Understand 504 coverage in Pre-kindergarten, Primary, Secondary and Post-Secondary environments

  • Understand the impact of COVID-19 on 504's and other accommodations

  • Identify resources and support to help during the upcoming school year

Please direct any questions related to this webinar by email to: education@biomatrixsprx.com

Thank you!


About Kelly Lynn Gonzalez
Regional Care Coordinator / Education Development Specialist @ BioMatrix Specialty Pharmacy

Kelly Lynn Gonzalez is a patient, parent of patients, and spouse in the rare disease community. Having personal experience with bleeding disorders, autoimmune disease, PIDD, epilepsy, and cancer – Kelly presents material colored by nearly three decades of experience managing chronic health conditions.

Her presentation style draws on both personal journey and professional expertise to educate, inspire and empower audiences. She channels a sincere passion for helping others facing chronic illness with previous experience as a teacher to lead heartfelt and dynamic programming. Kelly holds an MBA and MA in Education.


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HFA: a Texas-Sized Family Reunion

By Richard Vogel


It was wonderful seeing so many old friends—blood brothers and sisters with their families at HFA’s 2022 Symposium. The meeting was aptly named A Texas-Sized Family Reunion. Running into old friends at the airport was the start of the reunion!


Particularly enjoyable was Zander Masser presenting the keynote address, Unburying My Father. He recounts the story of his father, Randy, a professional photographer who had severe hemophilia B. When Zander was 14 years-old, his dad passed away from AIDS-related illnesses. As an adult, Zander “unburied” more than 10,000 photo slides of his dad’s work and took us through his process of exploring grief through creativity with the goal of helping others find ways of sharing their own grief. This was a pertinent topic when many of us are struggling and may have suffered losses through the pandemic.

Another interesting topic was On the Horizon, which focused on where we’ve been and where we are going with treatment and therapies for bleeding disorders. Presenters Dr. Allison Wheeler, Dr. Robert Sidonio, and David Clark, Ph.D, discussed long-lasting factor products, bypassing agents and gene therapy. Certainly, an exciting time for new therapy treatments in the world of bleeding disorders!

In addition to many great sessions, there were Open House gatherings for Blood Brothers, Blood Sisters, Blood Families, and Sangre Latina! Closing out the event was a showing of the movie Bombardier Blood, depicting the inspiring story of Chris Bombardier, a mountain climber with hemophilia.

The best part of a family reunion is just that – reuniting! We all had a lot of catching up to do! People could be seen engaged in conversations over breakfast, lunch, dinner, between meals and in the evening at the lobby bar. For the first big national event in a while, this Texas-sized family reunion did not disappoint, and I’m already looking forward to next year’s Symposium!

Congratulations to HFA on their keen insight and detailed planning!


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HFA Symposium: Reunited and It Feels So Good!

By Felix Garcia


The line at the registration table, the name tags with funny labels such as Disruptive, Bro-ster, and This Side Up (pointing the wrong way, of course)—and new this year, color-coded lanyards to signify contact comfort level given COVID-19, are all familiar parts of entering the HFA Symposium experience.


I missed attending the Symposium the last couple of years, though I didn’t realize how much until I was there. I even wore my name tag every day. Yes, that was an accomplishment for me! Like someone who has been deprived of basic needs and then values them that much more once they’re available, I appreciated being at the Symposium. There was so much to take in this year!

In San Antonio, Texas, April 20-23rd, HFA took precautions to help protect those in attendance from COVID-19. A mask mandate was in place, and as mentioned, our lanyards were color-coded, indicating our contact comfort level. Red meant “Keep your distance, please!” Orange, “Let’s talk but no hug.” And green signified, “Get over here—I missed you!” Okay, maybe green didn’t mean that exactly, but that’s what it felt like! As expected with our caring and compassionate community, everyone was respectful of each other’s preferences. I wore green—what can I say? I’m a hugger, missed my bleeding disorder family, and threw caution to the wind. Also, attendees could exchange their lanyard for another color if they opted to change comfort levels during the event.

Throughout the Symposium, attendees wore masks except while eating, so there was a lot of looking at someone, almost sure you recognized their eyes, but needing a peek of their face to be positive. It was a little funny to reunite with friends after flashing our faces.

If the Symposium was only about reuniting community members, the event was entirely successful. Lucky for us, they didn’t stop there. The variety of sessions was a hit, and the diversity of subjects, topics of inclusion, and the realization of all who are included in our community was impressive.

As an adult with severe hemophilia, I looked for particular topics like joint health and aging with hemophilia; as an adult who grew up in the 70s and 80s, I’m interested in other areas such as coping with co-morbidities and the remembrance ceremony. They were both available. Thank you, HFA, for remembering that we, the 3H generation—hemophilia, hepatitis, and HIV—still exists, and we needed a session of our own to attend with our spouses, partners, and loved ones.

Looking through the agenda schedule, most could find something of interest. Parent programs? Check. Children’s programs? Check. VWD programs? Check. Bleeding disorders and the LGBTQIA+ community? Check. How about sessions for rare bleeding disorders? Check again!

No matter your perspective or how a bleeding disorder impacts your life, HFA planned a session for you.

As others had mentioned, this year’s exhibit hall felt different. It had nothing to do with the booth setups or the give-away items. It took me two days of the designated hours to get through the hall because it was a time to reunite and catch up on the last few years. It was a wonderful opportunity to visit the booths, talk with the representatives, and learn about new products and services that have been introduced over the past couple of years. Though I’ve attended Zoom sessions with many of the people I saw at HFA, the exhibit hall provided a chance to catch up face-to-face. It was a breath of fresh air, even through a mask! 

The HFA Annual Symposium has always represented a family reunion for me. Seeing brothers and sisters from all over the country and having the chance to share our family and life issues is a beautiful thing. Our bleeding disorders family is unlike any other. Blood family is cherished, and our bleeding disorders family holds a special place in our hearts and lives. We were finally reunited, and it felt so good!

Bravo HFA, you did us proud!

Hemophilia Federation of America
2023 Symposium
April 13-16 | Orlando, Florida


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And the Men Went Fishing... (Well, Sort Of)

By Shelby Smoak, Ph.D.


The folly that follows hemophilia reigned again for a Men’s Fishing Retreat in Rehoboth Beach, Delaware, May 6-8th. Structured around a fishing experience, a veritable Nor-Easter took up camp offshore Friday evening and came ashore Saturday, whipping up waves into 12-foot froths of anger, spewing sheets of rain sideways on the shores and streets of the tiny beach town.


I was there. I saw the perfect storm brewing off the coast. I knew no vessel was going out to brave this storm, and if it was, I wasn’t going. Nor should any of my blood brothers. And when they arrived and we told participants the fishing boat was canceled, no one questioned the wisdom of that decision.

Yet, more miraculous than the wrath of nature outside, our event space was the spirit of the blood brothers—all adult men with hemophilia A or B. In a group familiar with upset plans, participants redirected the lost fishing opportunity into social hangs, poker tournaments, photography lessons, and, of course, numerous rap sessions sharing our various experiences with hemophilia.

Hosted by Country Boy Fishing and sponsored by Medexus, Octapharma, and BioMatrix—men along a cut of the Eastern Seaboard gathered to be together and bond. Fishing was the lure; the people were the real catch. In undistracted conversations, unfiltered honesty emerged, and a frequent refrain throughout the weekend was the lack of such opportunities for men with hemophilia to connect directly.

In addition to the more free-form rap session, structured programming provided more opportunities to engage in conversation. Brandon Young, a person with hemophilia, brought his unique brand of engagement in a discussion of mentorship and the support of “older persons with hemophilia” (a term this “older” person with hemophilia let slide). Octapharma introduced Dr. Claudio Sandoval who spoke on the importance of adherence to treatment therapies, which led to a myriad of discussions on bleeding and the promises of gene therapy.

Medexus brought in community member and fashion designer Christian Harris who coached us on how to buy clothes that actually fit. (Women may be surprised to learn just how interested we were in picking out appropriately fitting pants and shirts.)

My role included leading sessions on using photography as therapy, directing games, and sharing a final night singing session with fellow BioMatrix member and self-styled crooner, Terry Rice.

In truth, there was a Gilligan’s Island feel to the event in the camaraderie and mutual friendships that developed. Indeed, we sat back in with our own tale of a fateful trip whose outcome was far more positive than a group of sea goers stranded on a deserted island. These blood brothers—my friends—formed lasting bonds and left empowered, proof that even a perfect storm cannot dampen our spirits!


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Support Resources for Patients Taking Humira® (Adalimumab) Citrate-Free


At BioMatrix, we provide individualized specialty pharmacy services and support for patients requiring specialty and infused medications. We empower patients to live each day to its fullest potential.

Here we provide support resources for patients taking Humira® (adalimumab) Citrate-free (Humira CF). This information is intended for educational purposes only and should not replace directives from your physician or pharmacist. Refer to Humira’s Prescribing Information1, Medication Guide2, and website3 for more information. Never make any adjustments to your treatment plan without speaking to your physician or pharmacist first.


Drug Profile and Indicated Use

According to the Humira Prescribing Information1 and its website.3, Humira is a tumor necrosis factor (TNF) blocker. In other words, it blocks inflammation. Humira CF works the same as original Humira, but with less pain immediately following injection.* The active ingredient (adalimumab) is the same as it has been for over 15 years.

Humira CF is indicated for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS), Crohn’s Disease (CD), Ulcerative Colitis (UC), Plaque Psoriasis (Ps), Hidradenitis Suppurativa (HS), and Uveitis (UV).

*Compared to Humira 40 mg/0.8 mL.


Support Resources for Patients Taking Humira CF

Humira Complete is a support program designed to:

Sign up for Humira Complete here:
https://www.humira.com/humira-complete/register

For immediate questions or assistance, call 1.800.4HUMIRA (1.800.448.6472).


Our Commitment to Every Patient…  

To provide individualized specialty pharmacy and infusion services that improve health and empower patients to live each day to its fullest.

Learn more about the therapies we serve.


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References

  1. AbbVie Inc. (2021). Prescribing Information. https://www.rxabbvie.com/pdf/humira.pdf

  2. Medication Guide Humira® (Hu-MARE-ah)(Adalimumab) Injection, for Subcutaneous Use. (2021). https://www.rxabbvie.com/pdf/humira_medguide.pdf

  3. Humira® (adalimumab) Citrate-free. https://www.humira.com/citrate-free

  4. Humira Complete. https://www.humira.com/humira-complete

Medication Therapy Management



In the United States, there are approximately 1.5 million preventable adverse events related to medication mismanagement reported every year. This extensive public health issue results in $177 billion in costs, injury, and death. Pharmacists play a pivotal role in preventing medication adverse events through medication therapy management, also known as MTM. This is a collective term to describe various healthcare services provided by pharmacists and other healthcare professionals.


The purpose of MTM is to reduce medication errors and adverse reactions while optimizing patient outcomes. MTM programs typically include the following five components: medication therapy review, a personal medication record, a care plan developed by your pharmacist, intervention and/or referral documentation, and follow up.1 During a MTM session, you will speak with your pharmacist to discuss the medications you are taking. This will include your prescription, over the counter, supplement, and herbal medications. Your pharmacist will then assess if there are medications prescribed incorrectly, medications that could have a negative interaction if taken together, unnecessary medications, multiple of the same type of medications, and if you need any additional medications for health conditions that are not being treated or inappropriately treated. Your pharmacist will provide you with in depth education on your medications and follow up with you about how they are working.2

Some examples of MTM services a pharmacist may provide are:

  • Performing assessments of a patient’s health status
  • Developing a medication treatment plan
  • Working with providers to select, initiate, change, and administer medications
  • Evaluating and monitoring a patient’s response to their drug regimen. This can include the safety and efficacy of prescribed medication
  • Completing a comprehensive medication review to find, settle, and prevent problems related to a patient’s regimen
  • Providing support services, resources, and information that increase therapy adherence
  • Recording the care that was performed and providing essential information regarding the medication regimen to the patient and their healthcare providers
  • Educating patients and providing training to increase understanding of how to properly use their medication(s)3

MTM can be performed in any setting where a patient is taking a form of medication. Even though pharmacy practice settings vary, when a pharmacist provides MTM their goals are to ensure each patient is taking the correct medication for their health condition(s) and to achieve the best outcomes from their medication treatment. Anyone who is taking a non-prescription, prescription, herbal supplement, or dietary supplement can benefit from a MTM program. Those who benefit the most from MTM are patients with multiple health conditions, those who take multiple medications, those who have questions about their medications or require close monitoring on their medications, those who were recently hospitalized, those who use specialty medications, or those who fill their medications at multiple pharmacies.3

Specialty pharmacies such as BioMatrix often provide care for patients with complex, rare, or chronic health conditions. Specialized support including MTM can help patients achieve the best health outcomes. Working with prescribers, specialty pharmacists can provide comprehensive MTM services optimizing prescribed therapy.4 Effective MTM helps patients avoid adverse events, improve therapy adherence, and experience positive health outcomes. By helping patients access their prescribed therapy quickly, safely, and with the resources to properly manage treatment, specialty pharmacies deploying MTM play an essential part in a patient’s overall care.


Stay informed on the latest trends in healthcare and specialty pharmacy.

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References

  1. Medication Therapy Management (MTM) Services [Internet]. Home. [cited 2022 Jun 20]. Available from: https://www.pharmacist.com/Practice/Patient-Care-Services/Medication-Management 

  2. Medication therapy management (MTM) & Medication Therapy Review (MTR) [Internet]. South Dakota State University. [cited 2022 Jun 22]. Available from: https://www.sdstate.edu/your-pharmacist-knows/medication-therapy-management-mtm-medication-therapy-review-mtr 

  3. Medication therapy management (MTM) [Internet]. APhA Foundation. 2013 [cited 2022 Jun 20]. Available from: https://www.aphafoundation.org/medication-therapy-management 

  4. Shu-Ayanji F, Ogurchak J. Developing a framework for delivery of medication therapy management in a specialty pharmacy [Internet]. Pharmacy Times. Pharmacy Times; 2022 [cited 2022 Jun 20]. Available from: https://www.pharmacytimes.com/view/developing-a-framework-for-delivery-of-medication-therapy-management-in-a-specialty-pharmacy


Continuity of Care Support While Going Through a Permanent Change of Station (PCS)


Going through a Permanent Change of Station (PCS) is a big change, especially for military families caring for a child with a bleeding disorder.

Picking up and moving means building a new support network in an unfamiliar area while re-establishing new primary care providers/specialists, new schools, and new friends. It also means prolonged separation from a parent(s), leaving childcare to the remaining care-taker while being far from extended family.


Denise is a mother of four. Two of her children have hemophilia, and her husband is in the Army. She said in an interview with BioMatrix:

“We’ve moved a lot. Officially, we have PCS’d I believe 7 times, but we have moved for one reason or another about 14 times. Moving and re-establishing care is always an issue. First, we have to get the move approved by the Exceptional Family Member Program (EFMP). Once we move, we have to see a primary care physician before we receive a referral for the hematologist.”


Continuity of Care

Continuity of Care (COC) is a concept centered on the quality of care patients receive over time and a process where the patient’s care team is cooperatively working together for their good. Unfortunately, some populations are predisposed to issues with continuity—including those serving in our armed forces.

Prolonged separation from family members and frequent moving can negatively impact COC for military families. One analysis found that 44% of military families caring for children with special healthcare needs did not receive assistance coordinating care across providers.1

Though military families face COC challenges, specialty pharmacies are uniquely positioned to help them preserve their quality of care and health outcomes. They can help coordinate care across multiple healthcare access points for those with chronic conditions by:

  • Leveraging detailed clinical knowledge with individualized patient information to help providers fine tune treatment plans

  • Helping patients understand their coverage, coordinating health benefits, securing prompt authorization for prescribed therapy, and providing access to resources reducing barriers to care

  • Coordinating services between patient, provider, payer, and other community-based resources to overcome challenges, maintain continuity, and promote safe, effective care

Beyond filling a monthly prescription, the right specialty pharmacy can become an advocate and partner in the ongoing management of chronic health conditions.


As a nationwide, TRICARE-approved specialty pharmacy, BioMatrix is proud to serve the women and men of our military.

Providing seamless continuity of care for our TRICARE beneficiaries is both an honor and a privilege. We provide oral, injectable, and biologic medications used to treat complex health conditions and help implement complex treatment plans. By coordinating services between patient, provider, payer, and other community-based resources, we help bridge gaps, preserve continuity, and improve outcomes. 

We empower patients to better manage their condition and live each day to its fullest. Whether you’re a patient or provider, we want to be an advocate and supportive resource for you.


Permanent Change of Station (PCS) Resource Guide

Our Permanent Change of Station Resource Guide was designed specifically for military families caring for a child with a bleeding disorder. This resource includes:

  • Articles and guides to help you prepare for your PCS and information regarding recent changes to TRICARE

  • National organizations serving the bleeding disorders community

  • Local resources by TRICARE division including Hemophilia Treatment Centers, local bleeding disorders chapters, and camp programs for children with a bleeding disorder

Upon receiving your request, we'll email a copy of our PCS Resource Guide and include contact information for your local Regional Care Coordinator.


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References

  1. “Experience of Children with Special Health Care Needs in Tricare.” https://www.tricare.mil/Survey/Hcsurvey/childIssueBriefJan27_rev.pdf, Health Care Survey of DoD Beneficiaries. Nd.


The Many Ways Plasma Donations Help

By Shelby Smoak, Ph.D.


Because of the number of people who rely on plasma for medical treatment, there has been a growing need for years. Nearly 10,000 units of plasma are needed daily in the U.S. Plasma makes up only 55% of blood and is itself about 92% water, but is critical to life.1

Every year it takes approximately 1200 donations to treat 1 person with hemophilia; 900 donations for a person with Alpha-1; and more than 300 donations for a person with an immune deficiency. And that’s just a few of the many conditions plasma donation support.


Your Donations Matter!

To understand the myriad of ways your plasma can help, here’s a list of conditions where blood donations are essential for treatment:


General Conditions:
  • Anemia, or low hemoglobin: Condition where a person lacks enough healthy red blood cells to carry adequate oxygen to your body.
  • Animal bites: The CDC estimates almost 4.5 million dog bites occur each year2, of which many must be treated with plasma due to blood loss.
  • Cancer: Condition whose illness and therapy can cause reduction in platelets.
  • Hereditary angioedema: Rare, inherited disorder with accumulation of fluids outside of the blood vessels, blocking the normal flow of blood or lymphatic fluid.
  • Burn victims: Plasma works as a resuscitation fluid to restore intravascular volume status and vessel integrity.
  • Organ transplants: Organ donations are only one part of the equation for a successful transplant; plasma is the other.
  • Sickle cell: Inherited disorder that causes abnormally-formed red cell production whose “sickle” shape clogs blood vessels.
  • Surgery patients: Plasma helps persons undergoing extensive surgeries where blood loss is likely.
  • Trauma victims: Plasma aids those who have lost blood due to trauma.

Autoimmune and Immunodeficiences:

  • Primary immune deficiency (PID): Genetic condition that prevents the body’s immune system from functioning properly. Over 400 types are estimated with many treated by intravenous immunoglobulin (IVIG) therapy.

  • Chronic inflammatory demyelinating polyneuropathy (CIDP), or Guillain-Barre syndrome: Rare disorder in which your body’s immune system attacks your nerves.

  • Idiopathic thrombocytopenic purpura (ITP), or thrombocytopenia: Autoimmune disorder that results in low blood platelets, the cells essential for blood clotting.

  • Kawasaki disease: Disorder affecting children that causes swelling in blood vessels, especially coronary arteries.

  • Rh incompatibility: Condition during pregnancy where the mother’s blood type is Rh-negative and fetus is Rh-positive and sometimes requires IVIG therapy.

Blood Disorders:

  • Hemophilia A: Inherited bleeding disorder caused by lack of clotting Factor VIII.

  • Hemophilia B: Inherited bleeding disorder caused by lack of clotting Factor IX.

  • Von Willebrand disease (VWD): Most common bleeding disorder where a person is missing or has low amounts of clotting protein von Willebrand factor.

  • Alpha-1, antitrypsin deficiency: Hereditary disorder that results in low levels of AAT in the blood which can result in life-threatening lung and liver disease.

  • Thalassemia: Inherited blood disorder that causes your body to have less hemoglobin than normal.

  • Aplastic anemia: Rare but serious blood condition where bone marrow cannot make enough blood cells for your body to function normally.

  • Factor I (fibrinogen) deficiency: Inherited bleeding disorder missing fibrinogen which helps platelets “stick together” after injury

  • Factor II (prothrombin) deficiency: Inherited bleeding disorder where prothrombin, precursor to thrombin, is absent or malfunctioning.

  • Anti-Thrombin III deficiency, or thrombophilia: Inherited or acquired bleeding disorder whose lack causes higher than normal clot formations.

  • Factor V (proaccelerin) deficiency, also known as parahemophilia: Inherited bleeding disorder where protein catalyst FV is lacking, impacting the initial phase of the clotting process.

  • Factor VII (proconvertin) deficiency: Most common of the rare bleeding disorders where lack of FVII, which initiates clotting cascade, causes disruptions in clot formations.

  • Factor X (Stuart-Prower factor) deficiency: Inherited bleeding disorder with lack of Factor X protein which helps activate enzymes that help form a clot.

  • Factor XI deficiency, also known as hemophilia C: Inherited bleeding disorder with lack of Factor XI, which helps generate thrombin and leads to a clot within the factor cascade.

  • Factor XIII deficiency: The rarest factor deficiency disorder which lacks FXIII, which stabilizes the formation of clots.


Where Can I Donate Plasma?

To find a plasma donation center in your area, click the button below to visit donatingplasma.org.


Stay informed on the latest trends in healthcare and specialty pharmacy.

Sign up for our monthly e-newsletter, BioMatrix Abstract.

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References

  1. Red Cross. “What is Plasma in Blood?” 1 June 2022. https://www.redcrossblood.org/donate-blood/dlp/plasma-information.html

  2. CDC. qtd. in: “Animal Bite Accident Statistics.” LegalMatch.com. 1 June 2022. https://www.legalmatch.com/law-library/article/animal-bite-accident-statistics.html


Blood Draw Success!

By David Tignor and Rob Carter, RN


I can’t imagine there are many people who actually enjoy having their blood drawn; however, to maintain good health, routine blood draws are often necessary. This article reviews ways to help ensure blood draws are as easy and trouble free as possible.


As a person with severe hemophilia A, routine labs and blood draws are a part of my care routine. On a few occasions, I have experienced bleeds in the antecubital vein (the area in the bend of the arm) as a result of having the venipuncture. These bleeds were most likely due to one or more factors: the gauge of the blood draw needle, the unavoidable movement of the needle in the vein when collection tubes are placed and removed, how the needle is withdrawn from the vein, or even from the post-draw bending of the elbow, rather than keeping it straight, to place pressure after the needle is removed. If you live with a bleeding disorder you may have experienced similar issues. Luckily there are steps you can take to minimize negative effects from an infusion or blood draw.

If you have a bleeding disorder, chances are your veins are accessed on a more frequent basis than most individuals’. As such, it’s important to keep your veins happy and healthy. One great way to start well before an infusion is needed is through diet and exercise! Regular exercise will help your veins grow larger and stronger.


Additionally, following a healthy diet will ensure your veins recover quickly from frequent pokes and prods. Dietary suggestions include food rich in bioflavonoids (natural antioxidant compounds typically found in fruit), vitamin C, antioxidants, and fiber. This will help the elasticity and strength of the vein walls and valves. A healthy diet, plenty of exercise, and staying properly hydrated will have a positive impact on your veins and overall health.


We all know that our annual HTC visit will typically require labs to be drawn. Many hospitals and clinics will have a phlebotomist available to administer the blood draw. A phlebotomist is an individual who is trained and certified to draw blood. Typically, phlebotomists will use vacuum-sealed collection tubes in conjunction with an adapter/holder and a hypodermic needle. The size of a needle is determined by gauge numbers, which refer to the diameter, technically known as the “bore” of the needle. A larger gauge number indicates a smaller needle diameter or bore. For example, the bore of a 23-gauge needle is smaller than a 16-gauge needle (often used for blood donations). For adults, the most common blood draw needle size used to draw blood is a 21-gauge.

There can be a higher risk for those living with a bleeding disorder to have bruising, hematomas, or even a bleed at the venipuncture site when blood draw systems use a larger needle.


An alternative for preventing trauma to your vein is to use a butterfly needle. I have found that requesting a smaller gauge butterfly needle for blood draws has made a huge difference for me. A 23-gauge is the size typically used on children. Anything smaller, the needle would need to be in the vein too long and can cause hemolysis, which is the breaking down of red blood cells causing the release of hemoglobin into the surrounding fluid and may result in a ruined blood sample. 


Your phlebotomist can be asked to use a 23-gauge butterfly needle and most of the time they will comply without any issues. However, sometimes they have to follow a certain protocol when drawing blood and are allowed to use the smaller 23-gauge butterfly needles for children, or to control stress placed on small or fragile or rolling veins. If you are an adult and would prefer a smaller needle for your blood draw, talk to your hematologist or doctor and ask them to write, “Please use 23-gauge butterfly needle” on your blood draw orders. This will let the phlebotomist know there is a valid reason an adult with seemingly typical veins requires a 23-gauge butterfly needle for the venipuncture.


Especially for children, a numbing cream can be applied to the venipuncture site to help alleviate the pain of the needle stick. This will require time for the cream to work. Also, an excessively tight tourniquet is not needed and may cause bruising on tender skin. Placing the tourniquet over the sleeve instead of on bare skin can help with this. 


It is important to educate your phlebotomist about your bleeding disorder as it relates to the draw and advocate for your specific needs. In my case, I have pretty good veins and some phlebotomists do not understand why I am requesting a 23-gauge needle. I found it helps to have a quick conversation before the blood draw. Educating them about your condition and the steps that can be taken to minimize any issues is a great way to ensure a positive outcome. If you are not comfortable with their level of experience, you have the right to ask for another phlebotomist.

Phlebotomists have a demanding job and are sometimes rushed to get patients in and out of the lab. Sometimes being in a hurry can result in human error when extracting the needle, such as applying pressure while the needle is still in your arm instead of applying pressure after the needle is completely removed. This can cause unnecessary trauma in the vein. Remind the phlebotomist to remove the needle completely. Once gauze and a bandage are placed over the injection site, place gentle pressure for at least 5 minutes while keeping your arm straight. Bending your arm can cause the blood to pool resulting in a bruise. If certain adhesives cause skin irritation, be sure to remove the tape within 20 minutes. A Coban wrap instead of tape may also be requested.

Healthy veins are important for everyone, but for those living with a bleeding disorder, taking additional steps is key to preserving the access sites we depend on. By eating healthy, staying well hydrated, exercising, and working closely with your physician and the phlebotomist conducting blood draws, you can greatly improve your experience when it comes time to do labs or receive an infusion.


Tips for a Successful Blood Draw

Hydrate – Most important for a successful blood draw is to be hydrated. Drink plenty of water before your appointment to help dilate the veins. Avoid nicotine (cigarettes, vapes, chewing tobacco) and caffeine (sodas, coffee, energy drinks). These will constrict the veins making the draw more difficult.

Warm up – Being warm increases the blood flow and makes the veins easier to find. Take a warm shower before your appointment and keep yourself warm in cold temperatures. Do a few jumping jacks or rotate your arms around to get blood flowing. Hold a warm compress over the injection site for 15 minutes.

Use gravity – Let your arm hang down to increase blood flow. Make a fist or squeeze a stress ball. No need to pump your hand since doing so does not increase blood flow, especially once the tourniquet is on.

Relax and breathe normally - Being tense can lead veins to constrict. Don’t watch the venipuncture if it bothers you or makes you feel dizzy.

Sit still – Try to avoid making it more challenging! Hold a small child in your lap, and use distraction.

Speak up – If you’re prone to feeling dizzy when having your blood drawn, let your nurse or phlebotomist know before starting.


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Video: Safer Travels

This program is designed to help prepare a person to travel with reduced stress and anxiety.

Through travel tips, regulations, and rights as it pertains to traveling with chronic conditions, you can feel confident to navigate it all on your next trip.

Key Learning Objectives:

  • Learn about travel regulations, restrictions, and the impact they have on persons with chronic conditions

  • Learn travel preparedness opportunities

  • Understand how to seek access to care when out of state/country

  • Become informed about transporting medications while traveling

  • Alleviate stress and anxiety related to traveling

Please direct any questions related to this webinar by email to: education@biomatrixsprx.com

Thank you!


About Kelly Lynn Gonzalez
Regional Care Coordinator / Education Development Specialist @ BioMatrix Specialty Pharmacy

Kelly Lynn Gonzalez is a patient, parent of patients, and spouse in the rare disease community. Having personal experience with bleeding disorders, autoimmune disease, PIDD, epilepsy, and cancer – Kelly presents material colored by nearly three decades of experience managing chronic health conditions.

Her presentation style draws on both personal journey and professional expertise to educate, inspire and empower audiences. She channels a sincere passion for helping others facing chronic illness with previous experience as a teacher to lead heartfelt and dynamic programming. Kelly holds an MBA and MA in Education.


Stay informed on the latest trends in healthcare and specialty pharmacy.

Sign up for our monthly e-newsletter, BioMatrix Abstract.

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Don’t Be Surprised Anymore: The 2022 No Surprises Act

By Shelby Smoak, Ph.D.


This could happen to you: you’re on vacation and experience a terrible bleed in your foot. So tremendous is the pain that you grow concerned it may be a stress fracture. After a night of unrelenting pain, you call a nearby Urgent Care center and confirm they are in-network. No problem, you say. And you go. An X-ray is taken. The foot is diagnosed as not being broken. You go home.

Then the bills come. While all your services at the in-network clinic were covered as in-network costs, the X-ray was sent to a third party for review. And, well, they were out-of-network. Zing! Surprise! This results in a high-cost item not covered by insurance. This is an example of Surprise Billing and renders you helpless to negotiate the cost. There is nothing you could do about it… until now.

In January 2022, the No Surprises Act took effect. This bill is meant to end those nefarious charges that appear on the explanation of benefits (EOB) listed as “OON” or Out-of-Network and are the result of care received at in-network facilities. Let’s take a look at what the No Surprises Act is and isn’t.


What is a surprise bill?

The most succinct answer is that a surprise bill is an unexpected bill, but that could be any bill you hadn’t anticipated. Specific to healthcare and this act, a surprise bill refers to a balanced bill where a provider bills the patient for the difference between their charge and the amount paid by your health plan.


Why would someone receive a surprise bill?

A surprise bill is more often than not the result of an out-of-network charge. When a charge is in-network, the provider and the insurance plan have a previously agreed-upon arrangement for what the provider will charge and what the insurance will pay. With an out-of-network cost, no such agreement exists: the provider will charge what they feel is appropriate, the insurer will pay what they feel the service is worth. When these two figures do not align, usually with the provider asking for more than the insurer is willing to pay, the patient is billed by the provider for the balance difference, hence balanced billing.


In what scenarios might a surprise bill be received?

Numerous situations might lead to a surprise bill, but a majority of these can be related to emergency (ER) services. In these situations, providers often must act quickly. They may not be fully equipped for diagnosis and treatment within the facility and may use contracted help, as exampled above where the X-ray was read by a third-party source, even though the facility and X-ray technician were in-network at the facility. A blood draw and lab test may be taken where the phlebotomist is in-network, but the sample is farmed to a testing service that happens to be out-of-network.

Another common scenario may involve a procedure where a specialized provider, like an anesthesiologist, may be out-of-network, even though the procedure facility and the primary physician/surgeon are in-network.


How can you determine if your claim was an in- or out-of-network claim?

On most Explanation of Benefit (EOB) claim forms, these are noted or coded as OON (out-of-network), or the insurer’s EOB may include a note about the provider being out-of-network to indicate why the full provider cost is not being met. If you are unsure about the explanation on the EOB, you can also call the insurer for clarification.


What does the No Surprises Act cover?

According to the Centers for Medicare & Medicaid Services (CMS), the No Surprises Act provides consumers with “billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities.” It also provides out-of-network protections for air ambulance services.1


What situations do the No Surprises Act not cover?

The Act does not cover out-of-network billing from ground ambulance services. In many cases, a ground ambulance may be contracted with an in-network provider but be out-of-network with your insurance plan, and, unfortunately, the No Surprises Act does not offer patient protections in this situation.

The No Surprises Act also does not protect you if your provider (ER, hospital clinic or other facilities) is out-of-network. To be applicable, the out-of-network claim in question must have occurred within or at an in-network facility or provider.


What happens if my emergency care is at an out-of-network facility?

Unfortunately, the No Surprises Act does not specifically address this situation. However, emergency care is provided under the ACA and requires that providers must match in-network copayment and coinsurance rates when care is received at an out-of-network facility, so there would be some leverage for disputing an out-of-network charge in such an event.


Will the No Surprises Act automatically take effect when I receive an out-of-network bill?

No. The Act provides you with the protection to challenge the charge, but it does not require providers and insurance plans to flag out-of-network claims, nor are they required to determine if one of your out-of-network claims meets the criteria of a surprise bill. It is the patient’s responsibility to read the insurance plan’s EOB and determine if an out-of-network claim occurred at an in-network facility.


How do I dispute a medical claim that I think is a surprise bill?

If you believe you are the victim of a surprise bill, you can challenge the charge with the insurer and provider:

  1. Obtain the itemized bill from the provider

  2. Obtain an explanation of the charges from the medical provider

  3. If you are going to appeal, let your provider know and ask them not to send the outstanding bill to collections

  4. Call your insurer to discuss the charge

  5. Be sure to document all of your communications with the insurer and provider during this process. Take detailed notes—include manner of communication (email, phone, etc.), date, time, person’s name, and department. Request contact confirmation numbers when available.

CMS has designated an arbitration process for the plan and provider to work out the charges without your involvement. The important point is that once you receive a confirmation of a surprise bill, you should not be paying an additional fee, or settling the “balanced bill” with the provider.

The No Surprises Act is new to 2022 and is likely to have some bumps, but it’s important to know the law and know your rights. If you have any questions, please reach out to your RCC at BioMatrix or our education team at education@biomatrixsprx.com. We hope this helps you stay protected in 2022 and forward.


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References

  1. CMS. “Surprise Billing and Protecting Consumers.” 14 Jan. 2022. https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills.

  2. Controlling Costly Care: Lawmakers Weigh Surprise Billing, Transparency Legislation. https://cdn.theindianalawyer.com/wp-content/uploads/2020/02/Focus_SurpriseBills_IL021920_BradTurner.png
    Accessed 25 Jan. 2022.


Camp… Deeper Than The Surface

By Felix L. Garcia


Remember when the most phenomenal week of the year began when our feet hit the ground at bleeding disorders camp? For me, the joy of that week seems like yesterday, and at the same time, as if it were a lifetime ago. Those feelings get lost as we grow older. A few of us go back as counselors, but for most—school, jobs, relationships, and other grown-up obligations take their place. Those years at camp are precious.

When I was young, there were no camps near where we lived. When I was about 11 years old, my parents contacted the closest HTC in our state and arranged for me to attend. I was blown away! It was the most liberating week of my young life! Every cabin was full of boys just like me. I didn’t have to explain my bruises or why I was limping by the end of the day. After all, everyone else was limping too. There was comfort in knowing we were all going through the same challenges in our lives. We were happy to be together. I can’t think of a fonder memory than that week, and from the start, I looked forward to it all year long.

In my life back home, I was sort of an outcast. Kids looked at me as if I were strange. I was sometimes called a “faker” because I’d arrive at school in the morning just fine but would be in pain and limping by the end of the day. Keep in mind this was before the days of prophylaxis—I infused only when it was needed to treat a bleed. I can only imagine that home life was much the same for my hemophilia brothers. 

During my last 2 years at camp, I remember sitting with my cabin mates talking about the HIV/AIDS virus that was running rampant in our community. At that time, we all saw it as a death sentence. Treatment wasn’t what it is today. A couple of my fellow campers knew they had already contracted the virus, while many of us had also, but didn’t know it yet. We talked about how we were all eventually going to get it to help our diagnosed blood brothers feel better. Crazy how such a sad thought might bring comfort to someone. At the time, my parents knew I had HIV but kept it from me for a while. Camp was a safe place though—we talk about everything with each other.

As I look back through adult eyes, the camp experience was different then—in some ways better, but in others, it was barbaric! To me, the week was more about letting these poor kids have the time of their lives for a few days rather than trying to teach them anything. I can’t really say I remember learning much about life skills or how to prepare for the future. My biggest takeaway was learning how to self-infuse though, and that was a huge benefit. With a bleeding disorder, our life span was already jeopardized. Once HIV/AIDS entered the picture, we honestly didn’t have much of a future to look forward to. With no parents hovering over us in this newfound freedom, we weren’t afraid of anything—at least I wasn’t. That mentality may have led to my no longer being invited to camp.

During my last camp year as a 14-year-old, we swam and canoed along a small river where the campground was located. Just downstream was a Girl Scout camp. My cabin mates and I decided to sneak over to visit the girls’ camp. Our (untrained) counselors thought it was a great idea and did nothing to stop us—they cheered us on if anything. And so, with another boy and me deemed the ringleaders, we snuck off in the hush of the dark night in canoes, quietly and covertly passing the security guard… and we got away with it.

I got a kiss on the cheek from a Girl Scout that night. That would have been a sweet, sentimental camp story if it ended there, but of course, it didn’t. The next night, our last night, we organized another expedition to the girl’s camp. Having heard of our previous adventure, other campers joined us, and the group was much larger this time. We couldn’t all travel by canoe, so we had to make the trek on foot. This time, however, the whispers, giggles, and commotion were much too noisy, and we caught the attention of the security guard. Busted! Our adventure failed miserably!

The next morning, eager to avoid my parents learning about the trouble I had gotten into, I waited at the pick-up spot with my luggage. As soon as they drove up, I threw my bags in the car and said, “Let’s go!” We left without my parents ever hearing about what happened the previous night. During a post-camp meeting, it was decided the ringleaders (the other boy and I) were no longer to be invited back to camp. In more modern days, camp is an entirely different ball game. Rather than letting kids run around wild, the focus is on developing boys and girls to be productive, responsible adults who can care for themselves and manage their health condition. In addition to all the fun activities, a lot of rules and oversight to keep everyone safe and out of trouble have been implemented.

I had no idea how much that innocent kiss on the cheek would cost me. It was years before I realized the impact not attending camp would have on me. As a teenage boy with HIV and a debilitating chronic illness in the early 90s, it caused me to lose my support system—I needed my blood brothers. The years that followed were lonely—not a single fellow hemophiliac around. My circle got smaller and smaller as I grew distant from most people. I was a loner who tried to cover my pain with jokes. Those were dark days as the cloud of HIV loomed overhead… I lashed out, and my behavior spiraled to the point I became self-destructive.

It took years to eventually find my way out of that place. I had to learn to cope with the fear of death and the guilt of surviving. Since then, I’ve volunteered as a counselor for years (even at my old camp) and have held various positions within camp committees, always advocating for that one kid who needs more attention or direction. 

Once a boy in my cabin acted up and kicked out a window. I fought hard to keep him from being sent home. It turned out his medications had gotten mixed up, and he was off balance. His actions were not his fault. He was allowed to stay and was a perfect camper the rest of the week. I do everything I can to help the camp experience be the very best it can be for all children, not just the easy ones.

My experiences have taught me just how important bleeding disorders camp is for our youth. COVID-19 and its variants have, of course, done a number on our whole world, but on a smaller, more personal level, it’s been horrible for the young people in our bleeding disorders community. It may seem like just a week of fun, but it has taken away the experience of being with others who walk in similar shoes where no explanations are needed. We won’t know the real impact the isolation has on these young lives for years, if ever.

Many organizations understand the importance of camps and have done their best to provide get-togethers in the form of virtual meetings. We all know this isn’t at all the same as being on the campground, but if that’s all that’s available, then let’s get the kids to participate! I implore camp staff to keep volunteering—even if it’s a corny Zoom session, do it! You may not think so, but it does make a difference!

Make it a goal to reach out to former campers and their parents about attending. If you know of a child who is now of camp age, contact their parents and invite them to attend. Parents, we never know what is truly going on in the hearts and minds of our children. We only get to see the portion they choose to share with us. With fellow campers and even counselors, they may, and often do, share another side of themselves. Encourage your child to attend even if they don’t seem interested.

I challenge each of you to share my story and to make the effort to participate in camp. Let’s make sure we are here for our youth especially now when they need us most! 

#KeepCampGoing


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Summer Camps Are a Wonderful Thing!

By Sarah Henderson

Arkansas: Camp Nopokamee


Summer camps provide safe opportunities for children as they learn how to cope with life away from home, problem-solve, engage in critical thinking, and feel like they belong.

Kentucky: Center for Courageous Kids Camp

When a child has a medical challenge, we are often reluctant to send them to camp. Scary possibilities creep into the mind, and fear begins to take root. Let’s explore what happens when our children with a bleeding disorder attend camp.

The bleeding disorders community has many camps designed specifically for children with hemophilia, VWD, and other bleeding disorders. The skills, friends, and experiences your child will gain at camp are priceless.

As parents of children with a bleeding disorder, we have spent the first many years of their life protecting them from the world. The thought of sending your child off for the first time without you can be gut-wrenching. Just knowing you won’t be able to see and assess them and monitor bleeding prevention and treatment for a week is a hard pill to swallow. Adding to the stress is knowing these kids are going to participate in a lot of unfamiliar activities that we may have not considered acceptable due to the risk involved. A very important thing to remember is that the people you would call if a bleeding episode happened are the very people who will be diligently watching your children at camp! 

The medical staff stands by, interacting and teaching your child how to participate safely! Campers may find a new sport or hobby they never knew they would love. While at camp they will also spend time learning about their bleeding disorder. As parents, we sometimes forget our children will need to fully understand and be prepared to handle their disorder on their own. At camp, they can take responsibility and learn to become accountable for their bleeding disorder care. Kids need to learn and practice being independent so they can be ready to manage their own health as they grow to adulthood.

Many adults have fond memories of summer camp. Our children with bleeding disorders shouldn’t be excluded from these childhood adventures and friendships. At camp, kids find others who have similar life challenges and can make truly valuable, lifelong friendships.

There are many helpful things you can do to prepare your child for attending camp the first time. If your child knows you are feeling apprehensive about sending them, they will likely pick up on it and begin to feel anxiety as well. Talk about the experiences they will have from a positive perspective, and be excited for them! Be available to answer any questions they may have about camp. Ask chapter staff, HTC staff, or other parents for details about the specific camp so you are ready and able to answer your child’s questions. If possible, look at pictures of the camp from previous years as posted on the camp website, in newsletters, or on social media to show your child all the fun activities and the smiling faces of the campers.

A packing list will be provided upon camp registration. When packing, remember – camp is about kids having fun, making friends, and learning about themselves! Camp is NOT about what brand of clothes or shoes they are wearing or who has the best material possessions. Don’t put unnecessary pressure on your child by sending expensive or irreplaceable items. Let them have fun playing and getting dirty by packing old clothes and shoes that can get lost or ruined. Belongings will be stained, torn, shoved in corners or under bunks, packed up with wet clothes, or possibly used in the pranking of another cabin!

When packing, keep in mind not every item will make it back home. If your child is lacking old, worn-out clothes to pack, a trip to a resale shop could save a lot of money in the event their clothes don’t make it home. That’s also a great place to buy a duffel bag or backpack that may be ruined at camp.

There are various places to find camps that are good for our kids with bleeding disorders. First, right here in this newsletter is a list of camps around the country! Other parents are a great resource and are usually happy to share where their kids went to camp and about their experiences. Many adults with bleeding disorders may have fond memories to share about where they attended camp as a youth, or even now as a counselor. Your HTC and local chapter will be able to point you in the direction of local camps as well.

Summer camps provide your child with the opportunity to learn, engage, try new things, and play the same as a child without a bleeding disorder. The programs are specifically geared toward children with a bleeding disorder and are designed and implemented in a way that is safe and enjoyable. Your child will gain knowledge and experience around their specific bleeding disorder, learn independence, gain confidence, make lifelong friends, and enjoy a sense of belonging. Find your local camp, and register today to ensure your child doesn’t miss out on this life-changing experience!


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New Mexico’s Hybrid Camp

By Felix L. Garcia, Camp Counselor


That’s right – summer camp can be hybrid! In my home state of New Mexico, our bleeding disorders camp committee thought this would be the way to engage as many campers as possible, as safely as possible, given the potential hazards of COVID-19. Hybrid was different, to say the least, and by no means can it be compared to an in-person awesome week at the campground together but given the circumstances, it proved to be a great option. I’m a camp counselor, and this is my take on hybrid camp for children with bleeding disorders.

As an adult with hemophilia in my late 40’s, I went to bleeding disorders camp as a kid and eventually returned to serve as a counselor, program director and even camp director at various camps for kids affected by bleeding disorders. I’m currently a counselor and help create programming for Sangre de Oro Bleeding Disorder Foundation of New Mexico’s Camp Sangre Valiente. Last year, in an attempt to include as many campers as possible, the idea of a hybrid version of camp was encouraged.

Hybrid Camp means a camp that is both virtual via a Zoom platform and in-person. Our camp committee led by Camp Director Alfonso Jaramillo had to first decide what a hybrid camp was going to look like. We opted for an “on-the-road” style camp. This meant taking our camp program to a couple of sites in the state, while still hosting a virtual camp on other days. This was a lot to ask of the chapter staff and volunteers, but of course, the dedicated team decided it was worth the effort to provide the very best programming for our youth.

For ease of scheduling, we decided to have 3 consecutive days of virtual programming, followed by two days of in-person programming. Camp was held June 9-13, 2021. During our virtual programming June 9-11, we made meals from all over the world and included a bit of education on what it’s like to live with hemophilia in that region. Before camp, the registered families were sent the recipes, a grocery list and a gift card to purchase the ingredients so they could cook along… and cook along they did! I was able to represent Italy and led a program called Pizza Dude. My campers made their own pizza and learned a few key tips on how to order a pizza as well as how to order their factor and supply products from their specialty pharmacy.

On another day we made garlic noodles and chicken nuggets as we learned about bleeding disorders in Asia. Campers also made desserts with their other counselors, which was sweet! Virtual camp was attended by around 40 campers and family members who jumped in on the fun. It was a delicious and educational time!

The in-person part of our hybrid camp took place June 12-13. We sponsored travel and overnight accommodations for anyone 2 or more hours away from either of the two camp locations, Ruidoso and Albuquerque. What made the in-person camp experience extra special is that to have as many campers attend as possible, we opened the activities to the entire household. At each location, attendance was limited due to restrictions and precautions, but with more than 50 participants, we were still able to make awesome memories!

The chapter led a special arts & crafts project where we decorated shoes, which were later donated to the Ronald McDonald House in Albuquerque. After hearing from our guest speaker, Christopher Ingram, a professional bowler with severe hemophilia, families had an opportunity to enjoy a few games of bowling at nearby alleys. Christopher is a great role model, and his story was an awesome inspiration to us all.

And then there was the Gaga Pit. Any camper who has played Gaga knows it is a camp highlight! The pit was constructed with corral panels and everyone, especially the dads, had a riot!

This year, we are all hopeful in-person camp returns full force. As an adult, there is nothing like hanging with a bunch of kids to bring out the kid in you. If it turns out that we can’t gather in person, the New Mexico chapter and camp planners are ready to go hybrid again! Good luck to all the campers out there, and remember, even if camp is virtual, you don’t want to miss it!


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Meet the Team: Shelia Biljes


BioMatrix is dedicated to making a difference in the bleeding disorders community. Our team of Regional Care Coordinators and Patient Care Specialists provide support that draws on personal experience and a genuine commitment to the bleeding disorders community. Our Meet the Team segment invites you to get to know our incredible staff a little better. In this edition we feature Shelia Biljes.


”My advice for newly diagnosed families is to build a support team within the hemophilia community. Get involved, learn all you can, and try everything!”

Introducing Shelia Biljes! Shelia, her father, and her son have all been affected by hemophilia factor IX deficiency. These personal connections prompted a journey of service to the bleeding disorders community. Shelia is a tireless advocate, applying her personal experience to help connect, support, educate, and serve people with hemophilia and vWD. Based in the Cleveland area, Shelia primarily works in Ohio and Pennsylvania, but her long time involvement in the community and willingness to serve has led to connections and support for community members across the country. Get to know Shelia!


What brought you to BioMatrix?

For many years I was employed as a medical claims examiner. After my son was born, I volunteered at my HTC to help design educational programs for families with young children. A few years later, my career path turned toward the specialty pharmacy arena. Twenty-one years ago, I began serving patients with bleeding disorders, happily joining BioMatrix as a Regional Care Coordinator in 2017. It’s been wonderfully fulfilling!


Tell us about your family and connection to the community.

I was born in Cleveland, Ohio, and have lived in the area my whole life. My father had hemophilia, but I was only vaguely familiar with it growing up. His bleeding disorder was kept quiet because he feared losing his job if he missed work or if attention was brought to the costly treatment.

Becoming a mom was my greatest desire, and it came true with the birth of my daughter, Mika, followed by my son, Jordan, and then my daughter Miya. My dream was for a large family, but three babies riding in a double stroller proved to be enough!

During my second pregnancy, as an obligate carrier and knowing the baby was a boy, my doctor took extra precautions with the delivery. My son was diagnosed at birth with 2% moderate factor IX hemophilia. We were referred to a hematologist and put in contact with our local bleeding disorders chapter. The chapter invited us to their holiday party, which was scheduled for the next weekend. That day, Jordan was just 7 days old. I met people who became my second family, one full of love and support. Our friendships continue to this day, and I am still very active in my local chapter.

Our lives have evolved around the joy of raising our kids, and it’s been an extremely busy journey! We were very involved with school, church, Girl and Boy Scouts, ice skating, baseball games, music lessons, and more!

My daughters graduated high school with honors, Miya as Valedictorian and Mika as Salutatorian. My son completed his Eagle Scout and was Senior Class President. All three graduated college, and by this summer, all three will have master’s degrees. I am so proud of my kids. When I see them using their talents to help in the bleeding disorder community, my heart just swells!

With the kids grown and gone, my husband, Bill, and I are empty nesters currently residing in Columbia Station.


What is an interesting or unique fact about you?

In addition to hemophilia, my dad passed on to me his love of antique cars. He left my son a 1928 Model A, which we use to cruise around on Sunday afternoons. We also own a 1976 Cobra Mustang, a 1966 Oldsmobile 442 convertible, and a 1971 Kingswood Station wagon. The station wagon inspires many people to approach us and tell stories of trips taken in their family wagons back in the day. The car takes me to the days of being in the back of my dad’s wagon with my siblings small enough to sit side-by-side looking out the back window.


Who in your life has influenced you the most?

My father, a much-loved Baptist minister, was a huge influence in my life. He suffered quietly through bleeding episodes and illness caused by hepatitis C. In 2019, he was approved for hep C treatment around the same time a cancer diagnosis was received. Sadly, he lived only a few months longer.


Describe your most difficult challenge.

One of my greatest challenges was learning to infuse my son. Initially, we only infused for injuries, which always seemed to happen at bedtime, weekends, and holidays. My husband worked and went to college, so I found myself making doctor’s office or emergency room trips with all three little ones in tow. When my son turned two, we decided in order to have a more normal life, we needed to learn how to infuse. I was extremely nervous but pushed through the fear for the sake of our sanity and more independence. I encourage new parents to learn to infuse their child just as soon as possible. It makes a huge difference in managing a bleeding disorder.


What advice do you offer new families?

My advice for newly diagnosed families is to build a support team within the hemophilia community. Get involved, learn all you can, and try everything! I also suggest families speak to their HTC or medical provider about infusing before special occasions where a bleeding episode would be especially inconvenient. Keeping with the old saying, “an ounce of prevention is worth a pound of cure,” I remind them to slow down a minute and make sure their loved one’s prophy dose has been administered before letting the excitement of a moment overshadow the necessity of taking care of business. Looking back at my own experiences, we could have prevented some disappointments and extended healing times had we been more attentive to this.


What motivates you—what is your passion?

What motivates me is knowing there are still many families in this community to meet and hopefully provide a level of support. My focus for many years has been on uniting community members and watching friendships grow with every event.

As a former part-time wedding photographer, one of my passions is taking pictures. With my kids all grown and gone, my empty nest is now used to entertain my dogs. We have a Rottweiler named Greta Von Biljes, a pit bull, Flynn, and a little beagle, Nora Jean. I often watch my daughter’s dogs, another pit bull, and a labradoodle. All five dogs are subject to portrait sittings!

Sewing is another favorite pastime. Making quilted bedspreads, purses, totes, and table runners takes up some of the time I used to spend running around with my kids. When I make a project, who it is for is decided before I start sewing. As I work, I think about the recipient and fill the quilt with thoughts of love and good wishes. I recently hosted a sewing class for a wonderful group of hemophilia B ladies. It was an event that was so near and dear to my heart! Hopefully, they can use this activity as a future stress reliever.


What is your proudest achievement?

My proudest achievement was during a BioMatrix sponsored event at the Cleveland Aquarium. The topic was getting over the fear of infusing. Having a serious fear of sharks, I’ve never watched the whole Jaws movie. In fact, I won’t go into an ocean any further than my knees! However, on this occasion I donned scuba gear and swam in the shark tank. To surpass my greatest fear with the hope of encouraging someone to overcome their fear of infusing was worth it!


How do you feel you are Making a Difference?

By helping families understand overwhelming aspects of insurance and the medical system, I feel I am Making a Difference. I try to help patients navigate common insurance challenges and maintain access to care. It’s a challenge I enjoy and take seriously.

Every month, I host events for families to provide education and support. Themed events are my favorite to plan, and I try to incorporate education unobtrusively. Also, much of my free time is devoted to helping guide young people in our community into college or their chosen career.


What is the most cherished part of your job?

What I cherish most about being a Care Coordinator is when I can be a light in the darkness for a family with a newly diagnosed child. I remember the women who showed such compassion toward me at my first chapter event, and I try to make myself available for new mothers as I once was.

I have had the joy of watching many boys grow into amazing young men and am so glad to see women finally beginning to be properly diagnosed. As a woman “with hemophilia,” I am excited to have the opportunity to offer education and support to women who have been ignored over the years. Through the patients I serve, I feel I’ve been given the large family I had always wanted.

To contact Shelia Biljes, call 440-813-1626 or email: shelia.biljes@biomatrixsprx.com


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World Autoimmune Autoinflammatory Arthritis Day


Although many types of autoimmune disorders are rare, collectively they affect more than twenty-four million Americans.1 Autoimmune disorders occur when the body’s immune system mistakes its own healthy cells, tissues, and organs for foreign diseases and infections, therefore attacking and weakening healthy body function.

Though the cause for autoimmune disorders is mostly unknown, it’s widely accepted that both genetic and environmental factors can both contribute. With rare forms of autoimmune disorders, people can sometimes go years without being diagnosed.2


Autoimmune vs Autoinflammatory Diseases

As we bring attention to World Autoimmune Autoinflammatory Arthritis Day, it’s important to understand how autoimmune and autoinflammatory diseases are related yet different.3

Similarities

  • They’re both immune system disorders that result in inflammation
  • The treatment goal for both is the same—to block the inflammatory pathway activated in each disease
  • They each cause similar, persistent symptoms such as but not limited to fever, fatigue, rash, headache, muscle/joint swelling, shortness of breath, abdominal pain, enlarged lymph nodes, and red eyes

Differences

  • They result from different pathways of the immune system
  • Features of autoimmune disorders typically include onset in middle age, are more common in females, and have more inconsistent occurrence of symptoms with flares and remissions (ie worsening symptoms at irregular intervals)
  • Features of autoinflammatory disorders typically include onset in early childhood, have more consistent occurrence of symptoms (ie recurrent episodes of fever), and a strong family history of similar symptoms
  • Autoantibody testing is negative in autoinflammatory syndromes, but positive in autoimmune disease
  • An autoinflammatory disease usually requires genetic testing to confirm

The Connection Between Autoimmune Disease, Autoinflammatory Disease, and Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is an autoimmune (and sometimes autoinflammatory) disease that causes inflammation in joints such as hands, wrists, elbows, feet, ankles, and knees.

Though there are over one hundred types of autoimmune and autoinflammatory diseases in the world, RA is considered a core autoimmune arthritis disease.4 Unlike osteoarthritis which is caused from the wearing away of the cartilage that caps the bones in your joints, rheumatoid arthritis (RA) is caused by the immune system attacking the joints. Most commonly, RA is an autoimmune disorder. Though in rare occurrences, it can present as both autoimmune and autoinflammatory.5


Our Commitment to the Rheumatoid Arthritis (RA) Community

BioMatrix provides the latest RA medical treatments aimed at reducing arthritic pain while averting joint damage and deformity. Partnering with prescribing physicians, our expert pharmacists help patients simplify and manage RA treatment plans, reduce negative effects, and increase adherence—helping to remove the burden associated with RA.

Click here to learn more about our commitment to the RA community as well as individualized specialty pharmacy services, timely access to care, and focused education and support.


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References

  1. National Institutes of Health. (2005, March). Progress in Autoimmune Diseases Research. https://www.niaid.nih.gov/sites/default/files/adccfinal.pdf

  2. National Institute of Environmental Health Sciences. Autoimmune Diseases. https://www.niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm

  3. Kuruvilla, M. (2021, October 14). Autoinflammatory vs. Autoimmune Disease: What’s the Difference? https://www.goodrx.com/health-topic/autoimmune/autoimmune-vs-autoinflammatory-disease

  4. Firstpost. (2020, May 20). World Autoimmune Arthritis Day 2020: All you need to know about autoimmune arthritis diseases. https://www.firstpost.com/health/world-autoimmune-arthritis-day-2020-all-you-need-to-know-about-autoimmune-arthritis-diseases-8386551.html#:~:text=On%20May%2020%20every%20year,arthritis%20as%20a%20major%20component.

  5. Savic, S. Mistry, A. Wilson, A. Barcenas-Morales, G. Definer, R. Emery, P. McGonagle, D. Autoimmune-autoinflammatory Rheumatoid Arthritis Overlaps: a Rare but Potentially Important Subgroup of Diseases. https://rmdopen.bmj.com/content/3/2/e000550