The CRA also has an active advocacy committee that works to ensure patient access to rheumatology care.
“Our legislative efforts on copay assistance, prior authorization and step therapy to assist in covering required medication are also priorities, aimed at caring for the aging population,” Dr. Metyas says.
Tim Madden, partner at Madden Quiñonez Advocacy, who works with the CRA, says the current bills the CRA is working on include:
- AB 2180: Health care coverage: cost sharing. CRA was a co-sponsor with a number of patient advocacy groups including the Hemophilia Council of California, Cystic Fibrosis Research Institute, ALS Association and Sickle Cell Disease Foundation. Although it did not pass the legislature this year, the bill would have required health plans to apply all monies used for out-of-pocket costs toward a patient’s out-of-pocket requirements, regardless of whether the funds were their own or from a third-party source.
- SB 516: Health care coverage: prior authorization. This bill would create a process in which prior authorization would not be required for specified services if those prior authorization requests had been approved more than 90% of the time. This would reduce treatment delays for patients and administrative time and burden for providers.
- SB 966: Pharmacy benefits. This bill would establish oversight authority for the state to regulate pharmacy benefit managers (PBMs). With no current oversight, PBMs can impact the healthcare marketplace in a way that hurts both patients and physicians. The bill also includes provisions prohibiting PBMs from steering patients to a particular pharmacy.
CRA is considering sponsoring legislation in 2025 to prohibit PBMs and health plans from restricting patient access to in-office treatments.
Plans for the 2025 annual meeting are also underway. “We’re looking to do something special by combining all of our programs into one big meeting,” Ms. Castro says. “Our goal is to foster greater networking and collaboration between physicians, APPs and managers. It promises to be an incredible opportunity for everyone to connect, learn and grow together as professionals and a community.”
Linda Childers is a health writer located in the San Francisco Bay Area.
