At the American Medical Association (AMA) House of Delegates Special Meeting, held virtually Nov. 13–17, the ACR’s delegation led a successful effort to update AMA policies on home infusion and copay accumulators.
The ACR’s delegation authored Resolution 212, on Copay Accumulator Policies, which resulted in a consequential addition to AMA policy. Going forward, the AMA “will support federal and state legislation or regulation that would ban copay accumulator policies, including in federally regulated ERISA plans.” The ACR’s copay accumulator resolution had the support of six other specialties and the state medical associations of Georgia and New Jersey.
It is important, especially during the COVID-19 public health emergency, to ensure patients can afford to stay on their medications. Copay accumulator policies threaten patient access to medications by preventing funds received from copay assistance programs from being applied to patient deductibles. Once assistance funds are exhausted, a patient must pay the full deductible out-of-pocket and may be forced to discontinue treatment. Enacting bans on such policies will protect patients from the threat of losing access to needed therapies. Four states have already banned such accumulator policies. As state legislatures begin their 2021 sessions, the ACR contends that it is urgent for the AMA to have a clear policy to support accumulator ban legislation that protects patient access to critical therapies.
The ACR also co-authored Resolution 508 with the Association of Clinical Oncology to update the AMA’s policies on home infusion. The delegation successfully modified AMA home infusion policy to:
- Remove the AMA’s endorsement of home infusion for chemotherapy;
- Add that the decision to use home infusion should be the result of shared decision making by the physician and patient;
- Add that flexibilities for home infusions of biologics or chemotherapy during the COVID-19 public health emergency should only be considered when the benefits outweigh the potential risks;
- Shift AMA support for home infusion to focus mostly on antibiotics;
- Oppose any insurer requirement of home administration of drugs if the physician deems it not appropriate, or if precautions cannot be met to protect the patient and caregivers; and
- State that insurers should not withhold payment or prior authorization for settings outside of the home.
These changes move AMA policy on home infusion closer to ACR policy, as developed by the Committee on Rheumatologic Care and approved by the Board of Directors.
The ACR, despite being one of the smaller specialties in the House of Medicine, continues to work on behalf of its members to leverage opportunities to positively impact AMA policy and advocacy. ACR members can support this work by joining the AMA and renewing their AMA memberships each year. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is both an ACR and an AMA member adds to the strength of this effort. Join or renew your AMA membership in 2020 and receive valuable membership benefits while helping to advance rheumatology.