A Rheumatology Fellow Shares Her Journey to Capitol Hill via the ACR’s Advocacy 101 Program

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In summer 2017, I was a few months post-partum when I received an email announcing applications for the ACR’s Advocacy 101 program. It would take only a few days, but I asked my division director if it would be worth the time commitment. He questioned the career benefits of advocacy, but encouraged me to apply my outspoken personality toward improving patient care.

More than one year later, I continue to advocate for arthritis and remain enthusiastic about improving access to quality medical therapy. Although advocacy does not provide financial reimbursement, per se, the benefits to our patients, our subspecialty and, ultimately, our careers are indisputable.

The Program Explained

The Advocacy 101 (A101) program occurs in conjunction with Advocates for Arthritis (A4A) during September (i.e., Rheumatic Disease Awareness Month) and serves as a boot camp for fellows in training and fellowship program directors to educate and engage participants in healthcare policy and patient advocacy. The program begins with a casual welcome reception, allowing fellows a chance to network with the planning committee, as well as other fellows from pediatric and adult training programs. The first day is packed full of lectures, designed to educate advocacy newbies on the major components of healthcare policy and the challenges we face as clinicians. The day concludes with a large networking dinner, including A101 participants, members of the Government Affairs Committee (GAC), RheumPAC and the ACR Executive Committee.

The second day continues with educational lectures as part of the larger A4A program, which includes former A101 graduates, practicing rheumatologists, members of the interprofessional team (e.g., physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists) and patient advocates. The latter half of the session is interactive, allowing advocates an opportunity to meet their team members (often grouped by state), with whom they will spend the next—and final—day advocating on Capitol Hill.

The GAC preselects three major issues to present to lawmakers, and ACR staff members assist in scheduling meetings with members of Congress. The A101 and A4A programs prepare advocates for their big day on the Hill by reviewing expectations and prepping them on the three issues at hand. Although it seems overwhelming, committee and staff members work diligently to ensure all advocates are well prepared to discuss the current issues with legislators and fight for better patient care.

This Year

This year, we focused on step therapy legislation, dedicating medical research funding to arthritis in the Department of Defense’s (DoD’s) Congressionally Directed Medical Research Program and improved access to osteoporosis testing in Medicare. Specifically, we advocated for co-sponsorship of H.R. 2077 (https://tinyurl.com/y8zkm39b), a proposed law that seeks exceptions to step therapy and provides a reasonable and clear timeframe for insurance companies to assess the patient prior to denying medically necessary therapy, and we asked our senators to introduce companion legislation. This initiative piggybacks on our recent success within the U.S. Senate following a 98 to 2 vote on the pharmacy benefit manager gag clause bill, which prohibits Medicare insurers from banning pharmacies to inform patients that their prescription drugs would be cheaper if they were to pay out of pocket rather than through their insurance. This win is a huge leap toward drug-pricing transparency. In combination with step therapy legislation, we aim to progress toward individualized therapy for our patients (i.e., treat the patient and not the insurance policy).