Another area of focus has been the financial solvency of our members. We helped advocate for Congressional action to address this issue, such as the Paycheck Protection Program & other federal grant & loan programs.
In its most recent guidance update, the vaccine guidance task force included recommendations for mRNA vaccines over other vaccine types, given the option for additional doses of these vaccines in our patients. Other information is provided on post-exposure prophylaxis for vaccinated rheumatic patients using monoclonal antibodies against the spike protein of SARS-CoV-2. Additionally, in alignment with the recent recommendations from the CDC’s Advisory Committee on Immunization Practices, the task force is recommending a third dose of the Pfizer or Moderna vaccines to rheumatology patients taking a variety of immunosuppressive medications. Clinicians should also avail themselves of the detailed, specific recommendations on potential timing of immunomodulatory medications before and/or after vaccine doses to help their patients achieve optimal immune response.
These groups continue to keep an eye on the emerging science and governmental regulations, and they will continue to release updated guidance as we learn more.
Practice & Advocacy
The work of the COVID‑19 Practice and Advocacy Task Force was truly enormous in its scope. Although much of the remaining work has now been handed off to various ACR committees, including the Committee on Rheumatologic Care, I would like to commend all the work done by ACR staff and volunteers on these projects throughout the pandemic.
Throughout the pandemic, drugs that are needed by patients with rheumatic diseases have been of great interest in the treatment of COVID-19. We all remember the flurry of ill-advised interest in the use of hydroxychloroquine (HCQ) to treat COVID-19—a claim that has been disproved by many clinical trials. Nonetheless, this sparked a shortage of a drug that is critical for patients with lupus and rheumatoid arthritis. We worked closely with the U.S. Food & Drug Administration (FDA), drug manufacturers, pharmacists, other medical professional societies and patient advocacy groups, while also reaching out to commercial payers, the federal government, and governors and health departments from all 50 states.
Unfortunately, HCQ is not the only treatment that has been in short supply during the pandemic. On June 24, the FDA released an emergency use authorization for tocilizumab for the treatment of some hospitalized COVID-19 patients, leading to shortages of intravenous formulations of the therapy. Since spring of last year, the ACR has carefully monitored for shortages of this and related therapies—which received early research attention for their role in potentially attenuating cytokine storm-like symptoms in COVID-19—while advocating for continued access for patients with rheumatic disease. We are particularly concerned that our pediatric patients with juvenile idiopathic arthritis continue to be able to utilize tocilizumab. Fortunately, subcutaneous formulations (not authorized for COVID-19 use) are readily available. The ACR is actively working with the FDA’s Center for Drug Evaluation and Research drug shortage team to help the manufacturer resolve the shortage, and as this is being written intravenous formulations are expected to become available again late in August. Contact us at [email protected] if you are having trouble obtaining the medication for your patients.
Another area of focus has been the financial solvency of our members. We helped advocate for Congressional action to address this issue, such as the Paycheck Protection Program and other federal grant and loan programs. Moreover, we have provided streamlined information on these programs that have been essential to keep rheumatology practices open. We continue keeping an active eye out for our membership as updates occur in these areas.
Early in the pandemic, telehealth was a lifeline both for patients who were unwilling or unable to see their providers and for practices that needed to keep their doors open in a safe manner. Thankfully, the Centers for Medicare and Medicaid Services (CMS) put in place several flexibilities during the pandemic as part of the declared public health emergency, most importantly, the use of home-based telehealth visits. We successfully lobbied CMS and many commercial payers for parity in reimbursement for the audio-only visits that some patients needed. We also provided detailed information about telehealth coding and policy requirements, practicing telemedicine across state lines and other related topics.
Although some of these changes are expected to be permanent, it is unclear at present which will remain in place long term. Members may benefit from a recent episode of the ACR’s podcast, ACR on Air (ACRonAir.org), with reflections on telemedicine changes and opportunities in the past year. We continue to update the membership and advocate for policies that will allow the best aspects of telemedicine to continue, as a helpful supplement to in-person care, even after the public health emergency is lifted.
