The ACR Advocates for Drug Coverage, Payment Policies to Protect Rheumatology Patients, Practices

In addition to our advocacy work with payers, the ACR has also provided feedback on draft policies and formulary changes. Since this past summer, we have reviewed and commented on seven draft policies for three different carriers. It allows us to serve as a trusted resource and gives us the opportunity to help shape policies with evidence-based research and guidelines.

Goals for the Year Ahead

As we begin 2015, I look forward to expanding our influence with both private carriers and Medicare contractors. The ISC will continue to dialogue with private carriers to safeguard the practice of rheumatology. As we build on these relationships, we will seek further opportunities to review policies and formularies, and provide input on standard of care. We will also continue to provide individualized support for emerging policy and reimbursement issues.

In addition to working with private carriers, we will look to bolster relations with Medicare contractors. One approach we will use is expanding our resources for educating and communicating with Carrier Advisory Committee members (CACs). These members are in a unique position to engage proactively with Medicare contractors. Improved communication with CACs will allow us to better represent the interests of rheumatology providers and our Medicare patients.

These efforts will go hand in hand with increased collaboration with the Affiliate Society Council (ASC). The Board of Directors has recently demonstrated its commitment to advocacy on both insurance and state-level priorities by creating new staff positions dedicated to each of these areas. Through increased coordination and by working closely with the CACs and ASC representatives, we will be able to quickly identify emerging issues and generate a strong and unified response.

Finally, we will seek additional opportunities to partner with other medical specialty societies and coalitions in our outreach to insurers. Working together will enable us to pool our resources and influence to better advocate for access to high-quality care.

A foundation of successful relationships with the insurance industry is critical and will serve us well as we pursue our mission to Advance Rheumatology! I look forward to building on this foundation in the coming year as we continue to confront the challenges of access to care and treatments for our patients.

E. William St.Clair, MD, is president of the ACR and chief of the Duke Division of Rheumatology and Immunology. Dr. St.Clair, a rheumatologist, has 25 years of experience as a clinical investigator. Contact him at [email protected].