A new year is here, and that means the ACR is getting ready for state legislative sessions to begin again. In many states, 2020 marks the second year of a two-year session; in others, the session begins anew and bills are not carried over from 2019. However, 2020 is an election year, which means sessions will likely move quickly in part-time states as legislators rush to finish business to get back home to focus on electoral politics. With a shorter-than-usual window for victories, the ACR advocacy staff will be busy working on issues important to the rheumatology profession.
Utilization management reform will continue to be a focus in 2020. There were some big wins last year and we hope to build on that momentum at the state level. Step therapy reform efforts have been ongoing for the past few years in Florida, Massachusetts, North Carolina and Oregon and all are likely to see bills introduced again this session. Experience has shown us that persistence pays off in this fight. For example, last year we achieved big step therapy wins in Virginia, Georgia and Washington after multiple attempts in previous years. In 2020, we should be able add a few more states to the win column. We are also looking beyond 2020 and working on bill language with partners and potential sponsors in a few more states, with bill introduction targeted for 2021.
On the utilization management front, we will also focus on prior authorization. Although prior authorization reform continues to be more difficult than step therapy reform, we have some good prospects for success in the new year and will continue efforts in Florida, Oregon and Pennsylvania. Election years can create opportunities in states with organized provider and patient coalitions due to legislators’ increased sensitivity to constituent influence. This may lead to a few prior authorization wins as legislators look for issues to pad their electoral résumés going into election season.
Non-medical switching is an issue of growing importance to rheumatology professionals and the patient community. Payers continue to expand this practice of forcing patients to change treatments due to coverage changes or other non-medical reasons, leading to unnecessary treatment disruptions. We were on the cusp of a huge win late in 2019 as both chambers of the New York legislature overwhelmingly passed the state’s non-medical switching bill. The bill was transmitted to Gov. Andrew Cuomo’s office just before the holidays. Just when providers and patients thought they were about to get an early gift, Gov. Cuomo did his best Grinch impersonation and vetoed the bill. We will be working with our partners and bill sponsors in New York to make sure this bill lands back on his desk and that this time he signs the legislation.
We will continue to shop our model workforce legislation and are encouraged that we have had interest from legislators in a few states. However, we are still in an education posture on this issue. Rapid movement has been jeopardized not by legislators, but by shrinking budgets and erroneous policy analysis from legislative staff. We are currently working to help them understand that Health Resources and Services Administration (HRSA) and state loan forgiveness programs that include general internal medicine exclude subspecialties, such as rheumatology. Education is always a part of the legislative process, but on this issue we are clearly starting at square one.
Drug pricing and pharmacy benefit manager transparency will continue to be of importance, but there don’t seem to be any big pieces of legislation on these issues on the horizon this year. We will monitor all our issue areas and engage where we can have an impact. As always, we will continue to work with our partners to leverage our voice for the benefit of the rheumatology profession and patients.
In closing, I would be remiss not to thank every one of you who participate in our VoterVoice campaigns and who take time out of your busy schedules to meet, call and write legislators about the important issues affecting rheumatology. Our advocacy would not be nearly as impactful without you lending your voice to the fight. In the coming year, stay involved and urge your colleagues to get involved in advocacy as well. If advocacy is a new area for you, consider this pertinent statement from Greek statesman and general Pericles: “Just because you do not take an interest in politics doesn’t mean that politics won’t take an interest in you.”
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.
