Rheumatology Priorities Advanced at Busy AMA House of Delegates Meeting

The ACR and its delegation to the American Medical Association (AMA) House of Delegates (HOD) capped a busy and highly successful annual HOD meeting June 9–14 in Chicago. Hundreds of delegates from medical specialty societies and state medical associations gather at two AMA HOD meetings each year—in June and November—to set the policy and direction for the nation’s largest and most powerful physician organization.

Both of the ACR’s resolutions at this meeting—addressing the current National Institutes of Health (NIH) Public Access Plan and in-office dispensing of specialty drugs—were successfully passed with no changes in the HOD and will be adopted by the AMA. The ACR delegation also worked to shape policy discussions in a number of other areas affecting members, including use of biosimilars. Other topics addressed at the HOD meeting included updates to Medicare Physician Fee Schedule payments, budget cuts and budget neutrality issues, approaches to sustaining community practices, artificial intelligence in healthcare, prior authorization and many more.

The ACR’s delegation (L-R): Gary Bryant, MD; Adam Cooper, MS; Christina Downey, MD; Luke Barré, MD; Cristina Arriens, MD; Eileen Moynihan, MD; and Colin Edgerton, MD.

The new resolutions add to a long list of ACR-developed policies and directives previously passed by the AMA, addressing copay accumulator policy, third-party pharmacy benefit administrators, stakeholder engagement with Medicare Administrative Contractors, payer financial incentives to switch treatments, selective application of prior authorization, step therapy in Medicare Advantage, biosimilar interchangeability pathways, ensuring an effective H-1B visa program to enhance the rheumatology workforce, drug pricing, drug cost attribution in quality payment programs, pharmacy benefit manager (PBM) reform, opposing the previous Medicare Part B drug payment demonstration and more.

NIH Public Access Plan

Resolution 610, which addresses the proposed NIH Public Access Plan, was developed by the ACR in conjunction with 10 other specialty societies.

Joining the ACR in raising concerns and calling for AMA involvement as cosponsors of this resolution were the American Academy of Allergy, Asthma and Immunology; American Academy of Neurology; American College of Physicians; American Society of Anesthesiologists; American Society of Hematology; American Society for Radiation Oncology; American Thoracic Society; American Urological Association; Association for Clinical Oncology; and Endocrine Society. Resolution 610 also gained support in many caucuses and section councils, and support was expressed by the American Academy of Pediatrics, Cancer Caucus, Dermatology Section Council, Radiology Section Council, Pain and Palliative Medicine Section Council, American Psychiatric Association and Psychiatry Section Council and many others, as well as the Specialty and Service Section that represents more than half of the House and 125 different specialties.

“Although the concept of free, immediate and unfettered access to newly published research sounds enticing, the plan as proposed may not achieve the goals intended. In fact, there is a high likelihood of unintended consequences for equity, quality, peer review, scientific record oversight, financial sustainability and the very future of biomedical scientific research,” said Gary Bryant, MD, chair of the ACR’s delegation to the AMA.

Dr. Bryant continued, “The rapidity of the proposed plan, specifically the elimination of the 12-month embargo, would be extremely disruptive and likely negatively impact scholarly publishing and dissemination. There are many concerns and likely unintended consequences, and we thank all who supported this effort at the meeting. We will now look forward to working with the AMA and many stakeholders as we continue to address these issues with policy makers.”

As a result of this work and passage of the ACR’s resolution at the HOD meeting, the AMA will now work with publishing and professional organizations and Congress to raise awareness of possible adverse consequences of the proposed NIH Public Access Plan and to mitigate such consequences to ensure continued equitable access to quality clinical research.

This national policy advancement would not have happened without the ACR’s initiative to develop policy, convene other concerned stakeholder specialty societies and drive a coalition, nor without partnering societies’ help and substantial support at the meeting. This success was also possible because ACR members join and maintain memberships in the AMA, allowing the delegation representation at the meeting.

In-Office Specialty Drug Dispensing

The HOD also passed Resolution 246, authored by the Association for Clinical Oncology with the ACR as a cosponsor to advance policy to provide protections for practices related to office-based dispensing of specialty drugs.

The AMA will now request the Centers for Medicare & Medicaid Services (CMS) rescind its recent determination that delivery of medicine to a patient using the U.S. Postal Service, a commercial package service or a trusted surrogate violates the in-office exception of the physician self-referral law, commonly referred to as the Stark law. Additionally, if the CMS were not to change its position on disallowing the delivery of medicine to a patient using the U.S. Postal Service or a commercial package service, the AMA will call for legislation to clarify that a surrogate may deliver medicine dispensed at a physician-owned pharmacy without being in violation of the Stark law.

The Stark law prohibits a physician from referrals to entities in which they have a financial relationship, unless an exception applies (common exceptions include in-office ancillary services so that physicians can furnish designated health services to their practice’s patients). In-office dispensing of medication has been associated with improved patient access and adherence. Although the provisions of this resolution will not prevent insurers, PBMs and others from requiring use of selected delivery mechanisms (such as white bagging, brown bagging, etc.) to drive down costs by restricting patient choice, clarifying this exception to the Stark law would ensure physician practices that use an in-office pharmacy would be able to choose the best delivery method for their individual patients.

Shaping Policies on Biosimilars

At the meeting, the ACR and partnering societies were also able to raise concerns about and defeat a proposal, Resolution 102, that would have upended the current buy-and-bill system for the delivery of Part B medications by creating a fixed add-on payment for biosimilars and biologics, and potentially affect the biosimilar marketplace adversely. Instead of these changes to Part B, the ACR’s delegation suggested looking at changes to Part D, the area most in need of reform to lower costs and increase patient access.

The ACR’s delegation was also closely involved in deliberations and policy modifications during debates on Resolution 245 on the biosimilar interchangeability pathway policy. The ACR was able to represent and express the experiences of the rheumatology community with biosimilars, a prime topic as more biosimilars—including some interchangeable biosimilars—come onto the market. As a result of this work alongside multiple partners, the resolution was not passed and instead was referred for study by the AMA’s Council on Science and Public Health (CSAPH). The ACR will actively work with the Council to ensure the experiences and needs of rheumatology practices and patients are reflected in the resulting study and recommendations.

Resolutions are introduced and considered by the ACR based on its positions and policies and the work of ACR committees and the Board of Directors. The ACR’s delegation to the AMA House of Delegates consists of Gary Bryant, MD (delegate and delegation chair), Eileen Moynihan, MD (delegate), Cristina Arriens, MD (alternate delegate), Colin Edgerton, MD (alternate delegate), Luke Barre, MD (Young Physician Section representative), Christina Downey, MD (Young Physician Section representative) and Rami Diab, MD (Resident and Fellows Section representative).

The ACR asks rheumatologists to join or renew membership in the AMA so this work may continue. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is a member of both the ACR and the AMA adds to the strength of this effort. Visit the AMA’s membership site to join or renew your AMA membership and receive valuable membership benefits along with helping to advance rheumatology.

Input on the AMA delegation’s work on behalf of the rheumatology community—along with questions or suggestions for future House of Delegates meetings—can be directed to [email protected]. If you are experiencing specific issues with payers or have other practice concerns, the ACR offers individualized assistance to members of ACR and ARP. Write to [email protected] with your insurance, coding, billing and other practice issues.