Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

ACR Advocacy at the State Level in 2016

From the College  |  July 18, 2016

A majority of state legislatures have concluded their work for 2016. The ACR’s state advocacy efforts continued to focus on policy benefiting rheumatologists and patients alike. The two dominant issues this year were biosimilar substitution and step therapy.

Biosimilar Substitution
Biosimilar substitution remains the most prevalent issue throughout the states. The ACR continues to monitor all of these bills and to comment and take action on behalf of the rheumatology community.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The major biosimilars policy issue at the state level is centered on prescriber substitution. Meaning, if a lower-cost biosimilar that the FDA has deemed “interchangeable” is available, the pharmacist can dispense the lower-cost option. The ACR’s position on substitution is that the prescriber must be notified if a substitution takes place prior to or within 24 hours. Since 2012, some states have not required the prescriber to be notified of this type of substitution, creating potential patient safety issues. The ACR succeeded in working with partners, such as the Arthritis Foundation and others, and coalitions so that state substitution laws resemble the ACR’s policy.

In 2016, all biosimilar substitution legislation that was signed into law had prescriber notification of no longer than five business days.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Arizona, Idaho, Kentucky, Missouri, Oregon, & Rhode Island all passed biosimilar bills this year. The following states have passed legislation regarding biosimilar substitution in previous years: California, Colorado, Delaware, Florida, Georgia, Indiana, Illinois, Louisiana, Massachusetts, New Jersey, North Carolina, North Dakota, Tennessee, Texas, Utah, Virginia, Washington and Puerto Rico.

The FDA has not approved any interchangeable biosimilars for use.

Step Edits/Step Therapy Reform
Continued success for insurance reform has been seen throughout 2016. Legislatures were receptive to patient/consumer issues that arise from step therapy. The ACR does not support step therapy and believes that rheumatologists should direct their patients’ care, not insurance formularies. The reform measures that the ACR supported across the country would allow a physician to override an insurer’s step therapy protocol or reduce the time the patient has to participate in that step.

The ACR was effective in partnering with patient groups and others in support of these reforms and supported lobby days in state capitols across the country.

Illinois, Indiana, New York and West Virginia passed step therapy reform this year, with multiple bills still showing promise in other states.

Looking Forward
Insurance reform is still a major focus for patient and provider groups across the country. Payers of all kinds continue to put more pressure on providers by increasing the cost share for patients and through burdensome administrative requirements. This forces the providers’ offices to focus on navigating paperwork, allowing less time for increased access for patients.

The ACR continues to combat adverse health policies of all kinds through federal and state advocacy efforts. Make sure your state rheumatology society president is a member of the ACR’s Affiliate Society Council so your local policy leaders can stay up to date on all of the best practices from other states.

Page: 1 2 | Multi-Page
Share: 

Filed under:From the CollegeLegislation & AdvocacyProfessional Topics Tagged with:ACR advocacybiosimilar substitutionsstep therapy

Related Articles

    The ACR’s Advocacy at State Legislature Level in 2016 Focuses on Biosimilars, Step Therapy

    August 10, 2016

    Tashatuvango/shutterstock.com A majority of state legislatures have concluded their work for 2016. The ACR’s state advocacy efforts continued to focus on policy benefiting rheumatologists and patients alike. The two dominant issues this year were biosimilar substitution and step therapy. Biosimilar Substitution Biosimilar substitution remains the most prevalent issue throughout the states. The ACR continues to…

    Biosimilars Debate Heats up over Cost Savings, Safety Concerns

    Biosimilars Debate Heats up over Cost Savings, Safety Concerns

    April 15, 2016

    Biosimilars are much bigger and more complex on the molecular level than small- molecule drugs. On the right is the small-molecule structure of aspirin (21 molecules). On the left is a monoclonal antibody made up of 10,000–20,000 molecules. The various biosimilar drugs depicted include monoclonal antibodies, scFv, Fab, and scFab, whereas the small-molecule drugs are…

    Possible Impact of Biosimilar Infliximab on U.S. Market in Prescriptions, Pricing

    September 8, 2016

    paulista/shutterstock.com The use of biosimilars for rheuma­tology in the U.S. became a reality when the U.S. Food and Drug Administration (FDA) approved Inflectra (infliximab-dyyb), a biosimilar to Remicade (infliximab), in April. What this may mean is increased competition among drug companies with regard to pricing and, therefore, potentially lower costs for U.S. patients, according to…

    Rheumatology Drug Updates, Trials, Safety Data

    June 1, 2014

    Legislative news on biosimilars, safety warning on epidural corticosteroid injections, and other drug updates rheumatologists need to know

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences