Copay Accumulator & Maximizer Programs
Many rheumatology patients rely on manufacturer copay assistance to afford expensive treatments. However, copay accumulator and maximizer programs implemented by insurers and PBMs prevent these funds from counting toward patients’ deductibles or out-of-pocket maximums.
Once again, many states will be considering bills to regulate these practices, ensuring that copay assistance benefits patients directly. We expect bills to be reintroduced in all the states where they failed last year, plus a few more. Progress on this issue has been slower than we hoped but steady, and we remain optimistic about the possibilities for copay accumulator legislation in 2025.
Telehealth Initiatives
Since the pandemic, telehealth has become a fixture in many rheumatology practices. Although most people think of telehealth in terms of treating basic illnesses, telehealth has become a deeply valued flexibility for rheumatology patients and providers. In the coming year, we will continue to support telehealth reimbursement parity to give providers and patients the flexibility they need. This is especially important for patients in rural and underserved areas.
Telehealth has also proven important for patients and providers who live in areas where natural disasters are occurring or have recently occurred. Telehealth enables rheumatology patients to have undisrupted access to their provider even in the aftermath of hurricanes or wildfires. It has truly become an indispensable tool for rheumatology care, and the ACR is committed to preserving telehealth flexibility and reimbursement for the long term.
Your Engagement Is Imperative
The ACR will be weighing in on all these issues and more, but it is imperative that you speak out as well. As a rheumatology provider, you have a powerful voice to advocate for your patients and your profession. By engaging in advocacy, you can help shape policies to eliminate barriers to care, such as prior authorization delays, restrictive step-therapy protocols and inadequate insurance coverage for life-changing treatments.
Your expertise is invaluable to policymakers, who rely on informed perspectives to make decisions affecting healthcare. Advocacy doesn’t require extensive time or effort—writing letters, meeting with legislators and supporting RheumPAC can all make a profound impact.
Together, we can create a healthcare system that prioritizes the needs of patients with rheumatic diseases and empowers providers to deliver the best possible care. Your involvement matters now more than ever.
Joseph Cantrell, JD, is the director of state affairs and community relations for the ACR.
