The impact of arthritis and musculoskeletal diseases on healthcare costs is enormous, and patients should have access to medication that is safe and effective. The choice for any individual patient should be determined by his or her treating rheumatologist.
The ACR recognizes the duty of the treating physician to responsibly choose appropriate therapy, taking into account financial considerations, including direct costs of medication but also the indirect costs associated with loss of present and future productivity. It is not justifiable for third-party payers to attempt to influence medication selection by pre-authorization requirements, “preferred drug” status, or tiered levels of copayment without a sound scientific or medical bases for such approaches.
Patients are coalescing into a vocal, unified, and persuasive force in healthcare. They have made their need for these medications—and the great improvement in quality of life they have received from them—tangible and clear. Patients are advocating with CMS, Congress, employers who purchase their health insurance, and the media. As their partner, the ACR is committed to assuring that, as beneficiaries of health plans and as human beings, patients receive the respect and care they deserve.
The Model Biologics Policy is built from the experience and resources of the ACR, and can be used to educate insurance companies. It is a working policy and will be updated as new drugs are developed or if any drug is discontinued.
The policy is available on the ACR website under the Practice Management tab in the Clinical Support menu. For specific questions about this policy, contact Antanya Chung in the ACR’s practice management department at [email protected] or (404) 633-3777.