By May, many state legislatures have started to wind down their sessions. As those of us engaged in state advocacy enjoy this opportunity to catch our breath and slow down a bit, it is a great time to take stock of the wins and losses so far in the 2021 legislative session.
Utilization management reform continues to be a bright spot this session. Nine states have considered step therapy legislation this year. We have already had wins in Arkansas and Nebraska. Bills in California, Massachusetts, Arizona and Oregon are all still viable. Also, Georgia passed prior authorization reform unanimously in both chambers. The bill is currently with Governor Kemp and awaiting his signature or veto. Even with these state-level gains, and more potentially still on the table, it is important to remember that utilization management reform requires both state and federal solutions because of how insurance is regulated. That is why we continue to work to support the Safe Step Act in Congress.
Another issue where we have seen wins this session is copay accumulator ban legislation. More than 20 states have considered accumulator bans this year. So far, we have seen wins in Kentucky and Oklahoma, with more likely to come in some of the states that are still in session. The progress on this issue has been slower than we had hoped it might be, which has been slightly disappointing. However, it is important to remember that many states are in the first year of a two-year session, so many of these bills will carry over and still be viable next year.
We also had wins in pharmacy benefit manager (PBM) reform in West Virginia and Virginia. The Virginia bill offers some modest improvements over the existing state PBM law. The West Virginia bill is the most robust bill to have passed so far this session but still falls short of the Alliance for Transparent and Affordable Prescriptions (ATAP) and National Council of Insurance Legislators (NCOIL) model language that we prefer. Still, the West Virginia bill is a significant step in the right direction, especially when considered alongside Alabama’s PBM legislation that was thoroughly gutted of significant patient protections.
One of the more disappointing outcomes so far is the continued inability to advance any kind of health reform legislation in Florida. There are many reasons that Florida is a difficult state, such as the strength of the PBM and payer lobby. However, it also highlights the importance of state-level physician advocacy: The only way to overcome these obstacles is for physicians and other stakeholders to be more active in the state legislative process.
How You Can Help
The ACR offers many resources to help members become more active in advocacy. At the Legislative Action Center, you can send emails to your legislators to let them know where you stand on an issue. This is a simple, quick and effective way to participate in the legislative process. Most actions can be completed with only a click or two and take only a minute.
For those who would like to engage in advocacy more deeply, the ACR can provide additional support. We can help you schedule a meeting or call with your legislators and their staff and can provide background information and one-pagers on issues important to rheumatology professionals. In many cases, we can schedule a staff member to join the call or meeting with you, so you are not going it alone. Remember that you do not have to be a policy expert to talk with legislators and their staff members. Your point of view as a provider is enough. Our expert staff at the ACR can follow up with legislators to provide policy details as needed.
Additionally, if you are considering running for elected office, let us know. Although we cannot promise support, we can help talk through important considerations and what you should expect during the process. We can also tell you what it is like to work in a legislative body. Perceptions of the jobs of elected officials are often shaped by portrayals on the news and in popular media and may be inaccurate. The schedule can be grueling, the pace is ever changing and the conditions are not nearly as glamorous as most imagine them to be. Knowing what to expect on this journey is important and will give you a head start on many people who seek elected office.
The progress we have made so far this year, despite the pandemic and a political environment that is not conducive to ambitious reform measures, is encouraging. As summer approaches, I hope we all have the time and opportunity to take a moment, take a breath and appreciate the fact that we have made it through this unprecedented last year and, along the way, have made some important advances for the rheumatology community.
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.
