So far it has been a busy year for the Affiliate Society Council (ASC). Forty-three states are now affiliated with the ACR through the ASC, and we may add another next year. Also, many state legislative sessions have wrapped up, so it’s a great time to provide an overview of the successes—and some of the remaining challenges—for rheumatologists and their patients at state capitals around the country.
Almost every state has now passed biosimilar legislation in some form. While most states have a five-day notification for providers, some have a three-day notification period. Just this month, the Medical Association of the State of Alabama (MASA) was able to negotiate a one-day notification provision to let providers know when biosimilar substitutions are made. This is an important safety issue and provides essential transparency in the treatment delivery process for both clinicians and patients.
MASA worked closely with state specialty societies, including the Alabama Society for the Rheumatic Diseases, to achieve this victory. This effort highlights the importance of state rheumatology societies working closely with their state medical associations to galvanize support for policies that benefit our patients and practices. It’s also important to get to know the key people at your state medical society. One way to achieve this: Offer to be a resource for its efforts in directing public policy.
Step Therapy & Prior Authorization
Step therapy and prior authorization have long been banes to practicing clinicians. Codifying patient protections and simplifying the process insurers use in administering step therapy are ongoing priorities for the ACR. Currently, 22 states have some form of step therapy legislation to direct the administration process. This year, Virginia, Washington and Georgia all passed important step therapy legislation. The Virginia Society of Rheumatology’s efforts, led in large part by Harry Gewanter, MD, were integral to the successful passing of H.R. 2126. Like Dr. Gewanter, you too can get involved and explain to legislators how important these laws are for our patients—their constituents.
Drug Costs & PBMs
Drug costs are an important issue for voters, so this has been a year of intense scrutiny for pharmacy benefit managers (PBMs) at state and national levels. One hundred and ninety-eight bills with the intent to regulate PBMs and/or address rising drug prices were introduced in 45 states. Twenty-nine states have already banned gag clauses that prevent pharmacists from telling patients about lower-cost alternatives outside their insurance PBM pathway. Twenty-three states have eliminated claw-back provisions that affect the cost of medicines for our patients and the economic viability of the pharmacists who dispense them.