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.
The Power of Advocacy
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.
State Legislative Issues to Watch in 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.
ACR-Led Resolutions at AMA House of Delegates Meeting Protect Rheumatology Practices, Patient Access
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.
High Cost of Specialty Drugs Demands Action
Amid rising drug costs and the growing influence of pharmacy benefit managers on patient care decisions, physicians are increasingly called upon to advocate for affordable, evidence-based treatments for their patients.
Landmark Supreme Court Decision Supports States’ Rights to Regulate Pharmacy Benefit Managers
On Dec. 10, the Supreme Court of the United States of America (SCOTUS) issued a landmark decision in Rutledge, Attorney General of Arkansas, v. Pharmaceutical Care Management Association. In an 8–0 decision, the justices agreed that states have the right to impose regulations on pharmacy benefit managers (PBMs), companies that manage prescription drug benefits on…
U.S. Insurers Often Limit Biosimilar Coverage
(Reuters Health)—U.S. commercial health plans only covered biosimilar treatments as preferred products in 14% of coverage decisions last year, according to an analysis of publicly available data on coverage decisions.1 Researchers examined records from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database, which has information on coverage decisions made by 17 of…
The Plight of the Retail Pharmacist
She wanted me to call in an antibiotic. My sister, a lawyer, often tells me how the ethics of her profession govern even her extra-professional acts. She feels that when she was sworn into the New York State bar, she lost the freedom to bend the truth. She would never, for example, attempt to smuggle…
Copay Accumulator Programs Can Derail Rheumatologic Treatment Plans
As the medications for rheumatology become more expensive, the need for patient financial assistance becomes paramount. Unfortunately, commercially insured patients are finding it difficult to afford the exorbitant copays required by their plans, and the latest strategy of pharmacy benefit managers (PBMs) threatens to derail rheumatologic treatment goals. High deductible plans combined with copay accumulator…
Tips for Smoothing the Time-Consuming Prior Authorization Process
ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…