Workforce & Loan Repayment
The win: Both the House and Senate took up a bill reauthorizing the Pediatric Subspecialty Loan Repayment Programs; H.R. 2781 passed the House in October and is now in the Senate in the Health Education Labor and Pensions (HELP) Committee, where it was discussed in December in executive session.
Context: Pediatric rheumatology fellowship slots are filled around 50% of the time, while adult rheumatology fellowship slots must turn away applicants. The above legislation attempts to address the pediatric workforce shortage by providing funds for loan forgiveness when certain metrics are met.
How you can help: Send a letter to Congress encouraging the Senate to pass this important legislation.
FDA Approval for Biosimilar Interchangeability Pathway
The win: The FDA announced its approval for the interchangeability pathway for biosimilars.
Context: Biosimilars may be used as substitution of the reference product or interchangeable. The latter denotes that the drug can be used interchangeably with the reference product. No drug has yet been approved in rheumatology with interchangeable status in the U.S., but studies are ongoing. The FDA will require studies with three switches alternating between the reference product and biosimilar that report on the safety and efficacy of the drug.
Utilization Management and Reimbursement: Step Therapy, Prior Authorization & DXA Scans
For step therapy, H.R. 2279 was introduced in the spring in the House and has 124 bipartisan co-sponsors. The companion Senate bill, S. 2546, was introduced in the fall and has 12 bipartisan co-sponsors so far.
For prior authorization, H.R. 3107 was introduced in the House and has 155 bipartisan co-sponsors.
Context: Step therapy is a burden for providers and patients. This legislation requires Employee Retirement Income Security Act (ERISA) health plans to allow for reasonable overrides for physicians to be able to use certain medications. The prior authorization legislation will protect patients in Medicare Advantage plans that delay or deny access to care. It also supports reporting back to the CMS how often Medicare Advantage plans approve or deny medications and services. Funding for DXA reimbursement is at an all-time low. This legislation will set a $98 floor for DXA reimbursement.