In 2018, Arkansas took a remarkable step toward PBM accountability and transparency by regulating PBMs through the Office of the Insurance Commissioner. The ACR’s national and state representatives met with Gov. Asa Hutchinson (R.) to support this effort and represent the perspective of rheumatologists in this important policy change.
The ACR has also worked as a founding member of the Alliance for Transparent and Affordable Prescriptions (ATAP) to develop model PBM regulatory legislation for states that lack effective PBM oversight.
Although PBMs remain the main subject of state legislative action to control drug costs, the focus has shifted toward other segments of the drug supply chain: Many states have introduced legislation that would increase manufacturer pricing transparency, as well as bills that address price gouging in the pharmaceutical and insurance markets. States are feeling pressure from citizens to act to decrease drug prices, so we can expect them to look for increasingly creative, and potentially disruptive, ways to ease the economic pain consumers are feeling at the prescription counter.
Negative Legislation
Sometimes, advocacy requires opposing legislation or regulations that may harm our patients. The ACR played a key role in leading the coalition that defeated a measure in Rhode Island to codify copay accumulators. Had it passed, the measure would have created a significantly negative economic impact on any patient who must take a high-cost, subsidized medication.
The ACR also worked with a coalition of providers to prevent the New Hampshire Board of Pharmacy from imposing the USP 797 compounding standards in non-pharmaceutical settings, such as for office-based infusions or injections.
The Rheumatology Workforce
State advocacy also means looking toward the future of our profession and our ability to care for patients. The gap between the number of rheumatologists needed and the number of rheumatologists available to care for rheumatology patients in our country is growing; many areas are without rheumatologic care entirely. Public policy can be shaped to encourage young practitioners to select rheumatology and pediatric rheumatology training via incentives.
With this in mind, the ACR has crafted a model state loan forgiveness bill for cognitive care specialists who practice in underserved areas, but who do not qualify for Health Resources and Services Administration (HRSA) grants. This bill has been introduced in Georgia, and other states should closely examine the legislation as a means of attracting cognitive care specialists, such as rheumatologists, to underserved practice areas.
Advocacy Is a Team Sport
What does this mean to you? If you are an older rheumatologist, you can wind down your clinical practice, but stay active in patient care by increasing your advocacy efforts. If you are younger in your practice, you can start by realizing you have a choice to make: You can direct the future of healthcare policy through advocacy or end up a pawn in the game of healthcare delivery.
