The ACR is very concerned about the growing number of health plans requiring specialty pharmacy acquisition of in-office treatments. These requirements limit practices’ ability to continue providing these treatments and harm patient access to critical therapies.
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Despite advocacy from the ACR and other organizations, Blue Cross Blue Shield of Tennessee has indicated that it will move forward with implementation of its specialty pharmacy acquisition mandate on July 1, 2020. The ACR is concerned that the negative impact of this decision on practices and patients will be exacerbated by the timing of the change. During the current COVID-19 public health crisis, health plans are urged to avoid implementing any policy change that would increase administrative burden or further disrupt patient care.
Blue Cross Blue Shield of Tennessee and other select health plans have presented specialty pharmacy mandates to employers as a way to control spending on specialty drugs covered under their employer-sponsored health plans. The ACR is reaching out to these companies to provide information on the impact of these requirements on their employees and offers a template letter for practices interested in reaching out to their patients’ employers directly. In partnership with the Arthritis Foundation, the ACR has also created a fact sheet to help educate patients and employers about the harmful consequences of these specialty pharmacy mandates.
The ACR will continue to advocate against policies that mandate specialty pharmacy acquisition of in-office treatments. In response to the unprecedented challenges faced as a result of COVID-19, the ACR will also continue to urge payers to delay any policy that would increase administrative burden or disrupt patient care so that members can remain focused on patient care at this critical time.
For questions or more information, contact practice@rheumatology.org.