So far it has been a busy year for the Affiliate Society Council (ASC). Forty-three states are now affiliated with the ACR through the ASC, and we may add another next year. Also, many state legislative sessions have wrapped up, so it’s a great time to provide an overview of the successes—and some of the remaining challenges—for rheumatologists and their patients at state capitals around the country.
Christopher D. Adams, MD, FACP, FACR
Biosimilar Legislation
Almost every state has now passed biosimilar legislation in some form. While most states have a five-day notification for providers, some have a three-day notification period. Just this month, the Medical Association of the State of Alabama (MASA) was able to negotiate a one-day notification provision to let providers know when biosimilar substitutions are made. This is an important safety issue and provides essential transparency in the treatment delivery process for both clinicians and patients.
MASA worked closely with state specialty societies, including the Alabama Society for the Rheumatic Diseases, to achieve this victory. This effort highlights the importance of state rheumatology societies working closely with their state medical associations to galvanize support for policies that benefit our patients and practices. It’s also important to get to know the key people at your state medical society. One way to achieve this: Offer to be a resource for its efforts in directing public policy.
Step Therapy & Prior Authorization
Step therapy and prior authorization have long been banes to practicing clinicians. Codifying patient protections and simplifying the process insurers use in administering step therapy are ongoing priorities for the ACR. Currently, 22 states have some form of step therapy legislation to direct the administration process. This year, Virginia, Washington and Georgia all passed important step therapy legislation. The Virginia Society of Rheumatology’s efforts, led in large part by Harry Gewanter, MD, were integral to the successful passing of H.R. 2126. Like Dr. Gewanter, you too can get involved and explain to legislators how important these laws are for our patients—their constituents.
Drug Costs & PBMs
Drug costs are an important issue for voters, so this has been a year of intense scrutiny for pharmacy benefit managers (PBMs) at state and national levels. One hundred and ninety-eight bills with the intent to regulate PBMs and/or address rising drug prices were introduced in 45 states. Twenty-nine states have already banned gag clauses that prevent pharmacists from telling patients about lower-cost alternatives outside their insurance PBM pathway. Twenty-three states have eliminated claw-back provisions that affect the cost of medicines for our patients and the economic viability of the pharmacists who dispense them.
In 2018, Arkansas took a remarkable step toward PBM accountability and transparency by regulating PBMs through the Office of the Insurance Commissioner. The ACR’s national and state representatives met with Gov. Asa Hutchinson (R.) to support this effort and represent the perspective of rheumatologists in this important policy change.
The ACR has also worked as a founding member of the Alliance for Transparent and Affordable Prescriptions (ATAP) to develop model PBM regulatory legislation for states that lack effective PBM oversight.
Although PBMs remain the main subject of state legislative action to control drug costs, the focus has shifted toward other segments of the drug supply chain: Many states have introduced legislation that would increase manufacturer pricing transparency, as well as bills that address price gouging in the pharmaceutical and insurance markets. States are feeling pressure from citizens to act to decrease drug prices, so we can expect them to look for increasingly creative, and potentially disruptive, ways to ease the economic pain consumers are feeling at the prescription counter.
Negative Legislation
Sometimes, advocacy requires opposing legislation or regulations that may harm our patients. The ACR played a key role in leading the coalition that defeated a measure in Rhode Island to codify copay accumulators. Had it passed, the measure would have created a significantly negative economic impact on any patient who must take a high-cost, subsidized medication.
The ACR also worked with a coalition of providers to prevent the New Hampshire Board of Pharmacy from imposing the USP 797 compounding standards in non-pharmaceutical settings, such as for office-based infusions or injections.
The Rheumatology Workforce
State advocacy also means looking toward the future of our profession and our ability to care for patients. The gap between the number of rheumatologists needed and the number of rheumatologists available to care for rheumatology patients in our country is growing; many areas are without rheumatologic care entirely. Public policy can be shaped to encourage young practitioners to select rheumatology and pediatric rheumatology training via incentives.
With this in mind, the ACR has crafted a model state loan forgiveness bill for cognitive care specialists who practice in underserved areas, but who do not qualify for Health Resources and Services Administration (HRSA) grants. This bill has been introduced in Georgia, and other states should closely examine the legislation as a means of attracting cognitive care specialists, such as rheumatologists, to underserved practice areas.
Advocacy Is a Team Sport
What does this mean to you? If you are an older rheumatologist, you can wind down your clinical practice, but stay active in patient care by increasing your advocacy efforts. If you are younger in your practice, you can start by realizing you have a choice to make: You can direct the future of healthcare policy through advocacy or end up a pawn in the game of healthcare delivery.
Former Speaker of the U.S. House of Representatives Tip O’Neil once said, “All politics is local.” Rheumatologists and rheumatology professionals can put this knowledge to good use. Meet your state representatives, and offer to become a resource on patient care concerns for them. Contact the influencers at your state medical society, and offer the same. Join the ACR advocacy Google group to keep up with issues around the country. Spend a few minutes talking to motivated patients. They can join you at the Legislative Action Center to write letters to legislators about the issues of importance to rheumatology.
Remember: Advocacy is a team sport, and—now more than ever—we need rheumatologists and patients to get off the bench and on the playing field.
Christopher D. Adams, MD, FACP, FACR, is chief of rheumatology for the East Alabama Rheumatology Center in Auburn/Opelika. His experience includes military medical practice (including health delivery logistics), clinical faculty at several medical schools, conducting clinical research and serving as the governmental affairs and managed care liaison for the Alabama Society for the Rheumatic Diseases. Dr. Adams is also the chair of the ACR’s Affiliate Society Council.
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.
