As a growing number of health plans enact policies that require specialty pharmacy acquisition of in-office treatments, the ACR is greatly concerned about the impact of these changes on rheumatology practices and patients. This concern has increased in the face of the COVID-19 public health crisis, as we urge health plans to avoid any policy change that would increase administrate burden or disrupt patient care.
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Blue Cross Blue Shield of Tennessee (BCBST) announced in fall 2019 that all specialty drugs would have to be acquired through the BCBST specialty pharmacy network as of Jan. 1, 2020. After hearing significant opposition from stakeholders, it pushed back the implementation date to July 1, 2020. If BCBST moves forward with this policy, the ACR is concerned that other payers could follow their lead.
The ACR has led two sign-on letters to BCBST since the payer’s initial announcement. The first letter was co-signed by 10 other state and national rheumatology organizations. After the policy was delayed, the ACR sent a second letter with support from several other specialties, including dermatology, gastroenterology, neurology and urology. The ACR also issued a press release highlighting the coalition letter and detailing our concerns about the proposed policy’s impact on patient access to treatment.
Members in other states have reported similar specialty pharmacy mandates in various employer-sponsored plans. In these cases, the restrictions are included in the plans’ benefit design and may be presented to employers as an opportunity to reduce costs without additional information on how patients and providers will be impacted or how the payer or pharmacy benefit manager may benefit. ACR has partnered with the Arthritis Foundation on a one-pager to help educate patients and employers about the harmful consequences of these specialty pharmacy mandates.
The ACR will continue to advocate against any policy mandating specialty pharmacy acquisition of in-office treatments. During the unprecedented COVID-19 public health emergency, the ACR is also advocating that BCBST and other payers delay implementation of any policies that would increase administrate burden or disrupt patient care so that members can remain focused on patient care at this critical time.
For questions or more information, contact practic[email protected].