As state legislatures gavel in for 2021, they face many of the same challenges that they confronted in 2020. COVID-19 will continue to loom large over the public policy landscape through 2021. States face budget shortfalls, vaccine distribution problems and strained healthcare infrastructure—urgent issues that will continue to grab headlines. However, there are opportunities for significant policy wins for rheumatology this session, particularly on the issues of step therapy reform, telemedicine and copay accumulators. Here is a preview of what to expect in state legislatures in another unusual year.
Step Therapy Reform
This will be an important year for step therapy reform. Twenty-nine states have already passed some variety of reform measure, and nine states—including Arizona, Arkansas, California, Florida, Nebraska, Oregon and Tennessee—are already considering the legislation this year. It is important to note the overall national status of step therapy reform right now. We are moving toward an inflection point that is reminiscent of what we observed a few years ago with biosimilar substitution legislation, which has now been adopted in every state. In three to five years, we might be able to say the same about step therapy reform. As we continue to chip away at the remaining states without step therapy reform legislation, our work to pass the federal Safe Step Act becomes even more crucial to ensure that everyone has the same, common sense step therapy protections.
Telemedicine became an important issue last year when COVID-19 emerged as a public health threat. At the beginning of the pandemic, we did not have an adequate policy framework in place to deal with all the potentially problematic situations that could arise from greatly expanded use of telemedicine. Issues quickly emerged, especially relating to telemedicine across state borders and state licensing requirements. Legislatures have been scrambling to catch up to the rapidly evolving telemedicine landscape, and it is evident in the early bill filings. We expect to see almost every state consider some type of telemedicine legislation this year. Although not all of these bills will impact rheumatology, we must carefully monitor and track them to ensure that our members, and the patients they treat, are not negatively impacted by any policy changes.
Copay accumulator legislation will move into a growing spotlight in 2021, with more than 20 states likely to consider bans this year. This issue is particularly important right now. Patients continue to face economic challenges and uncertainty during the pandemic. If copay assistance is not allowed to apply toward plan deductibles, patients are more likely than ever to discontinue their medications during a time when keeping patients stable on their medications should be a priority. Recognizing the importance of this issue in this moment, the ACR introduced and led a resolution for the American Medical Association (AMA) House of Delegates meeting at the end of last year on this issue. The resolution was approved and, for the first time, made it official AMA policy to support the adoption of accumulator bans at the state and federal level. The ACR is committed to vigorously supporting accumulator ban legislation and we are actively working with coalition partners across the country on this important and timely issue.
We do expect to see some movement on our other issues, such as drug pricing transparency, prior authorization and non-medical switching. However, we expect to see significantly fewer bills on prior authorization and non-medical switching than on the three main issues described above. There will be many pieces of legislation addressing drug price transparency, but we are not expecting to see many sweeping pharmacy benefit manager reform measures like those we have seen in the past. The bills that have been introduced so far are narrow in scope but much more viable in the current environment than larger reform packages.
How You Can Help
Finally, it is important to address the proverbial elephant in the room. COVID-19 has dramatically changed the way that we interact with legislators. The primary challenge that we will face as an advocacy community in 2021 is developing strategies to effectively advocate when we cannot advocate in person. This year, your participation and use of digital platforms are more important than ever to help ensure advocacy wins. Visit the ACR’s Legislative Action Center and complete the federal and state alerts throughout the year. The voices and support of our members have always been what makes our advocacy wins possible. During this public health emergency and worldwide pandemic, we need those voices to be louder than ever before. You can also contact the ACR’s advocacy team for help with issues you are experiencing in your area or practice by emailing [email protected].
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.