The ACR/ARHP’s annual fly-in to D.C. (#Act4Arthritis) was a huge success. More than 100 ACR/ARHP members and patients from across the nation attended meetings on Capitol Hill to advocate for people living with rheumatic diseases. In all, our advocates visited 138 Senate and House offices.
This year’s fly-in on Sept. 25–26 coincided with the second-annual Rheumatic Disease Awareness Month (#RDAM): September 2017. RDAM seeks to improve policymakers’ understanding and awareness of rheumatic diseases, and the unique and significant healthcare challenges facing Americans living with these chronic, painful and debilitating conditions.
During our visits, we discussed three policy issues currently affecting rheumatology patients and their ability to access quality, affordable healthcare. You can learn more about the issues below and take action from home.
- Reduce Patients’ Out-of-Pocket Expenses
H.R. 2999, the Patients’ Access to Treatments Act (PATA), has been introduced in the House of Representatives to limit patients’ cost-sharing requirements under specialty-tier drug pricing systems common among insurers and to increase access to life-saving biologics. We are asking Senate members to introduce PATA in the Senate and to request a Senate hearing on the use of specialty-tier drug pricing by insurers. You can help achieve this by asking your members of Congress to support PATA and combat the use of specialty tiers.
- Repeal Medicare Therapy Caps
In 1997, as part of the Balanced Budget Act, Congress instituted arbitrary caps on Medicare outpatient therapy services, including physical therapy, speech language pathology and occupational therapy, in an attempt to achieve enough cost savings to balance the federal budget. These therapy caps threaten the health and well-being of millions of Medicare patients who live with rheumatic diseases and rely on vital therapy services to manage their chronic conditions. Therapy caps force patients to bear 100% of the cost of care—something many cannot afford. Fortunately, Congress has acted 16 times to temporarily prevent these caps’ implementation, with the current exemption expiring on Dec. 31, 2017. Permanent repeal of therapy caps via the Medicare Access to Rehabilitation Services Act (H.R. 807/S. 253) has overwhelming bipartisan support. You can add your voice by asking your patients to urge your member of Congress to co-sponsor H.R. 775 and get rid of these caps once and for all.
- Change the Role of Pharmacy Benefit Managers in Prescription Drug Pricing
It is vital that lawmakers come to understand the role that pharmacy benefit managers (PBMs) play in the pricing of prescription drugs:
- PBMs can drive up drug costs by creating market pressure for higher list prices (the higher the list price, the higher the rebate).
- PBMs use their position to negotiate contracts with manufacturers, insurers and pharmacies that maximize their profits, often at the expense of patients.
- PBMs use spread pricing in which they charge an insurer a different amount for given drugs than what they reimburse the pharmacy for dispensing the drugs. This may be kept as extra profit by the PBM.
- PBMs use drug-switching practices, which increase profits by steering patients toward expensive medications whose manufacturers pay rebates to PBMs for promoting a particular drug.
