“When pharmacy benefit managers [PBMs] came into being 30 years ago, they were seen as an important component of the prescription distribution system [because] they could guide benefits and money between the patient, pharmacy and the manufacturer,” says Angus Worthing, MD, president of the Alliance for Transparent & Affordable Prescriptions (ATAP). Health insurance companies hire…
This legislative season has seen key pharmacy benefit manager reforms but slow movement on other issues, such as copay accumulators and utilization management. The ACR is also monitoring emerging topics, such as biomarker testing and post-public health emergency telehealth reforms.
A recent meeting of the National Council of Insurance Legislators (NCOIL) featured discussions of many topics important to ACR members, including pharmacy benefit manager legislation, biomarker testing and transparency in the healthcare market.
With 2023 state legislative sessions underway, early prevailing themes may forecast areas where we will see gains this year. Key issues include utilization management, copay accumulator bans, white bagging and pharmacy benefit manager reform.
At the AMA House of Delegates meeting in November, the ACR’s delegation will lead over a dozen cosponsoring specialties and medical associations in advancing a resolution addressing serious concerns about third-party pharmacy benefit administrators and the impacts of their disruptive practices.
As of July 1, a Florida bill increases oversight of pharmacy benefit managers and offers some protection for pharmacies. However, the legislation has limited effects on patients and providers, highlighting the need for additional reform.
The ACR is working with partners in several states to legislate against policies that require physicians to acquire provider-administered drugs through a preferred specialty pharmacy designated by a payer or pharmacy benefit manager.
In 1916, a handful of conservation advocates successfully lobbied Congress to create the National Park Service, which now protects more than 85 million acres of U.S. land. Dedicated rheumatology advocacy has lasting effects, too, as evidenced by several policy wins in 2021 and efforts underway for 2022.
States increasingly take the lead on issues critical to our members and the field of rheumatology, including copay accumulator bans, white bagging restrictions, prior authorization and drug pricing.
If passed, the ACR-led resolutions will direct the AMA to advocate for state-level pharmacy benefit manager reform and to fix broken Medicare Administrator Contractor processes. Several other specialties joined the ACR’s resolutions as supporting cosponsors.