Call To Action Advocacy : Advocacy Tools & Resources : Advocacy : Get Involved : Colorado Chapter National Hemophilia Foundation

Call to Action Advocacy

We are excited to introduce a new way for our local community to use their voices to advocate for themselves and for our cause. This new tool will provide community members with the ability to connect with and advocate to their local legislators with the click of a button.

This tool will allow you to reach out to your legislator using a template that will already be populated with a call-to-action message as well as your legislator's information. All you will need to do is write your name and hit send!

If you would like, you will have the ability to edit and personalize the message in your email, but it will not be required to make a difference!

Opt In TODAY!

Share your story!

There are hundreds of scenarios that we know can have a negative impact on the Bleeding Disorder Community and we want to hear your story! If you're interested in sharing your story and advocating on behalf of the community, please complete the form below.

Name

First Name *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Email (Required)

Relationship to Bleeding Disorder

Hemophilia A (Factor 8)
Hemophilia B (Factor 9)
VwD
Thrombosis
Other Rare Bleeding Disorder
Caregiver
Carrier
Factor 7
Factor 13

Have you or a family member experienced pressure from your employer to find another source of health insurance or faced threats of or actual job loss?

Yes
No
I prefer not to disclose

Have you or a family member experienced difficulty finding a medical/dental provider in your area who was willing to provide care?

Yes
No
I prefer not to disclose

Have you or a family member experienced any of the following issues with your medications:

Difficulty with obtaining medication because your bleeding disorder is mild.
Difficulty obtaining your medication because you live in a rural part of the state
Difficult obtaining medication due to availability or cost, to the point of not taking your medication as prescribed
Delays in obtaining medications after moving to COBRA insurance
Delays in obtaining medications from your pharmacy due to internal pharmacy rules
I prefer not to disclose

Have you or a family member had any of the following:

Step Therapy Requirements. This is where you are required to try a certain drug before you can try the drug your doctor prescribed
Mid-Year Medication List Changes. This is where a certain medication is approved at the beginning of the year, but removed later in the year, with no change to your insurance plan.
Accumulator Adjuster Requirements. This is where any manufacturer co-pay assistance you may receive is not applied to your insurance deductible. The money is kept by the insurance company with no credit for you.
Difficulty in determining if your medication is covered under your insurance plan during the open enrollment period.
The Hemophilia Treatment Center being out-of-network, or not in your plan.
Mid-Year Provider/Facility List Changes. This is where a certain provider/facility is available at the beginning of the year, but removed later in the year, with no change to your insurance plan.
Pharmacy choice is restricted by the insurance company, resulting in higher pricing for your medications, higher co-pays, or poorer service.
I prefer not to disclose

If you would like to share your personal experience with any of the issues listed above, or any other issues you've encountered, please do so here. You are encouraged to use this space to elaborate on how the issues you or your loved ones have faced have directly impacted you.

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Can we contact you for additional information to help in our advocacy efforts? Your information can be kept confidential. (Required)

Waiver of Liability/ Permission to use statements

I/my family choose(s) to participate voluntarily in the 2022 Advocacy program that is specified herein and is hosted by the Colorado Chapter of the National Hemophilia Foundation (NHF Colorado).

As a lawful consideration for being permitted by NHF Colorado to participate in the event, I hereby for myself, my heirs, my administrators, my personal representatives, and my assigns, forever release and discharge NHF Colorado, its board, directors, officers, employees, and agents—collectively the Released Parties— from any and all liabilities, losses, costs, claims, demands or causes of action—collectively Liabilities—that I may hereafter have for damages, injuries, and death arising out of my participation in this NHF Colorado event. This agreement will not apply to willful, reckless or intentional acts of Released Parties.

As a participant(s) in various activities of NHF Colorado we would like your permission to use your provided statements of you and/or your child(ren) to be used in future promotion of NHF Colorado programs. These statements may be used in publications or reports related to NHF Colorado or online tools such as our website, e-newsletter, Facebook, or blog. Additionally, these statements may be used in publications by NHF Colorado partner organizations for ongoing advocacy efforts. These organizations include but are not limited to the Chronic Care Collaborative (CCC), Hemophilia Treatment Center (HTC), the National Hemophilia Foundation, and local, state, and federal legislators. If you are not comfortable with our using your names or identifying information in the captions please let us know that information. Your permission to take and use statements of you and your child(ren) is strictly voluntary and will not affect your participation or the participation of your child(ren) in the programs and activities offered by NHF Colorado or your status or the status of your child(ren) as NHF Colorado members.

I understand that I will not receive any form of compensation now or in the future for the use of the statements provided. I understand that my consent to the use of the statements is forever.

I have carefully read the above release and agreement and am fully familiar with its contents. I agree that this release and agreement will be governed by Colorado law and is intended to be as broad and inclusive as permitted by the law of Colorado. I also agree that if any portion of it is held invalid, the balance shall, notwithstanding, continue in full legal force and effect. This waiver of liability shall be binding upon myself, my heirs, my administrators, my personal representatives, and my assigns.