Five states passed step therapy reform this year, bringing the total number of states with step therapy legislation up to 30. Additionally, Georgia, Oregon and Texas passed prior authorization reform bills. The Texas legislation included a gold card that allows providers with a 90% approval rate to be exempt from prior authorization requirements. It is the first legislation of its kind and we will work for this to serve as a model for other states moving forward.
Research Funding
We have sent letters to Congress urging medical research support for the National Institutes of Health (NIH) in the infrastructure legislative package and emergency funding of $10 billion to be sent to the NIH. Additionally, we have worked to dedicate a line item for arthritis in the Department of Defense Congressionally Directed Medical Research Program, as well as to request $10 billion in funding for the Centers for Disease Control & Prevention (CDC), with money directed toward the CDC Arthritis Program.
How Can You Help?
Sign up to receive advocacy alerts and send a letter to Congress to highlight issues the rheumatology community is facing—lawmakers do read notes from constituents. Be sure to respond to future calls to action in your inbox by sending letters to state and federal legislators to address health policy.
As we look ahead in 2022, the ACR government affairs team will continue moving forward with the policies outlined above, as well as tackling some additional issues noted below.
Drug Pricing
Pharmacy benefit managers (PBMs) operate without fiduciary responsibility to patients and through opaque practices. The PBM Accountability Study Act (S. 298/H.R. 1819) would require PBMs to report to the Government Accountability Office and would study PBM practices for future legislative fixes.
Additionally, the Build Back Better Act, as passed by the House (and in the version currently stalled in the Senate), would require pharmacy benefit managers to report compensation, costs, fees and rebates every six months to group health plan sponsors. This encouraging move demonstrates an appetite for such transparency measures in Congress.
Reimbursement & Access to Care
This is one of the more pressing issues to act on. At the very end of 2021, the House of Medicine was facing cumulative 9.75% cuts to Medicare reimbursement. In the last minute of legislating, these cuts were averted by the Protecting Access to Medicare Act, but only temporarily. In the coming year, these cuts will be phased back in, and members of Congress will need to hear our voices describing how these cuts will affect patient access to care. Watch for action alerts in your inbox to add your voice to these efforts.
