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.
How you can help: With the 117th Congress, all bills will need re-introduction in 2021. Send a letter to Congress showing your support. Also, watch for calls to action to send letters to state legislators if you live in a state that has not passed step therapy reform.
Up Next
As we look ahead in 2021, the ACR government affairs team will be tackling several issues:
- Advocating for support for patients and providers during the remainder of the pandemic and monitoring any legislation and regulations that could affect provider and practice solvency;
- Protecting rheumatology evaluation and management payment increases;
- Engaging on policies related to telemedicine;
- Advancing legislation and regulations in the areas of:
- Prior authorization and other utilization management issues;
- Workforce;
- Telemedicine expansion and appropriate reimbursement; and
- NIH/DOD funding for rheumatology research;
- Engaging on drug pricing proposed policies and pilot programs and defending patient access to treatment;
- Addressing issues such as DXA and musculoskeletal ultrasound reimbursement; and
- Monitoring implementation of the new requirements related to surprise billing, including the rollout of the independent dispute resolution program through which payers and providers will negotiate reimbursement.
Thank you for your time, efforts, enthusiasm and perseverance. I look forward to an ongoing conversation about how advocacy and health policy affect you and your patients and how you can help. Join us for an advocacy event, we would love to see you!
Wishing you and yours a Happy (and safe) New Year!
Blair Solow is chair of the ACR Government Affairs Committee and an assistant professor of medicine in the Division of Rheumatic Diseases at UT Southwestern Medical Center in Dallas.
