Understaffed, Over-Scrutinized & Feeling Powerless? ACR Advocacy Can Help

PHILADELPHIA—We all share a simple goal: taking good care of our patients. But the American healthcare system makes that difficult sometimes. Prior authorization headaches. Lack of patient access to medications for rheumatic conditions and, all too often, lack of access to a rheumatologist. The list goes on.

At ACR Convergence 2022, Elizabeth “Blair” Solow, MD, MSc, associate professor of medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, and outgoing chair of the ACR’s Government Affairs Committee (GAC), updated attendees on the top political issues affecting rheumatology in 2022 and what the ACR is doing about them. Then Angus Worthing, MD, FACP, FACR, Arthritis & Rheumatism Associates, PC, and clinical assistant professor of medicine, Georgetown University Medical Center, Washington, D.C, discussed why every one of us should advocate and how to do it. 

Top Issues

Dr. Solow kicked off her talk with an overview of the GAC’s advocacy priorities, which fall into three main buckets: 1) access to care; 2) access to medications; and 3) research funding.¹

Dr. Solow

The rheumatology community has seen progress in several arenas, including reform of strategies used by payers to contain costs, often at the expense of patient care. For example, step therapy protocols require patients to fail to respond to certain drugs before receiving approval to receive more expensive therapies, such as biologics—often regardless of clinical circumstances. Some states, including Pennsylvania and Massachusetts, have passed legislation to mitigate these protocols, and legislation to implement changes on a federal level has bipartisan support in both the House and Senate. States have also made headway on mitigating the burden of prior authorization and outlawing copay accumulator policies, and the ACR is advocating for federal changes as well.²

Drug pricing remains an issue for both new and older medications. One recent win was a provision in this summer’s Inflation Reduction Act that will allow Medicare to negotiate drug pricing in the future. “There are some caveats,” Dr. Solow said, “but I think this is an amazing first step toward lower drug pricing, especially given the current congressional environment.”

Dr. Solow also shared great news that demonstrates the impact rheumatologists can have when we raise our voices. Pharmacy benefit managers (PBMs) are an opaque problem that the Federal Trade Commission (FTC) had decided not to investigate. In response, the ACR and approximately 24,000 others sent comments to the FTC, ultimately leading to the reversal of this decision.³ “An investigation is now underway, and we’re hoping for an update on the report in 2023,” Dr. Solow said.

To conclude, Dr. Solow thanked the audience and said, “We love to and need to hear from you. What GAC focuses on each year depends on what our research group and rheumatology practitioners tell us we need to be focusing on. The more we amplify our voice, the more effective we’ll be in passing legislation that makes it easier to take care of patients.”

Why & How to Advocate

Dr. Worthing opened his talk with a big picture overview of the U.S. healthcare system. “About 25% of the U.S. budget goes toward health, so there’s a huge number of lobbyists from various stakeholders—e.g., pharmaceutical companies, physicians, etc.—involved,” he explained. “Rheumatologists only account for about 0.6% of all doctors, but we have a huge agenda to push through. So we need to leverage the ACR’s voice.” 

Dr. Worthing

The ACR exercises its voice in several ways: coalitions, op-eds, press reports, Capitol Hill fly-ins, RheumPAC (see below), involvement in the American Medical Association (AMA) and grassroots emails from ACR members. Regarding the latter, Dr. Worthing engaged the audience in a quick and easy advocacy exercise that was as simple as texting the word “MEDICARE” to 345-345. In response, participants received a texted link that allowed them each to automatically send a message to the district representative and two senators who represent them in Congress. 

For other ways to advocate, Dr. Worthing shared an “advocacy bucket list”:

1. Visit the Legislative Action Center on the ACR website to send more messages to your lawmakers;
2. Call, write letters or use social media to engage your local and state congresspeople;
3. Get involved with your state rheumatology society;
4. Make a state law;
5. Join the AMA;
6. Get your patients and friends involved;
7. Join one of the ACR’s twice-yearly visits to Capitol Hill for Advocacy 101 and Advocates for Arthritis; and
8. Consider investing in RheumPAC or the Rheumatology Research Foundation.

RheumPAC is the ACR’s nonpartisan political action committee (PAC), which works to elect and support pro-rheumatology candidates. It was created in 2007 with the mission of educating, electing and supporting federal lawmakers who understand and can positively address the issues that impact rheumatology care providers and their patients. The Rheumatology Research Foundation is the largest private funding source for rheumatology research and training in the U.S.

Although we wish it weren’t true, caring for our patients involves more than just seeing them in clinic and writing prescriptions. The extra work can leave us feeling powerless, understaffed and over-scrutinized. Taking action toward better policies and practices can help fight those feelings, and the ACR is here to help.

Samantha C. Shapiro, MD, is the executive editor of Harrison’s Principles of Internal Medicine. As a clinician educator, she practices telerheumatology and writes for both medical and lay audiences.

References

1. Elizabeth “Blair” Solow, MD. Advocacy highlights & fall treats: Reflections from the GAC chair. The Rheumatologist, 2022 Oct 21. https://www.the-rheumatologist.org/article/advocacy-highlights-fall-treats-reflections-from-the-gac-chair/.
2. Samantha C. Shapiro, MD. Advocacy Leadership Conference: Reflections from an accidental rheumatology advocate. The Rheumatologist, 2022 May 19. https://www.the-rheumatologist.org/article/advocacy-leadership-conference-reflections-from-an-accidental-rheumatology-advocate/.
3. American College of Rheumatology. ACR applauds FTC decision to investigate PBM business practices. 2022 June 7. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1218.