Key Talking Points
High on the agenda will be continued advocacy on ways to increase patient access to treatment—such as addressing step therapy requirements—and increasing the rheumatology workforce. Specifically, the ACR is asking for a number of measures that would help address the rheumatology workforce shortage, including ensuring options for new rheumatologists to repay and reduce student loan payments, and provisions to allow more international doctors trained in the U.S. to remain in the country if they practice in underserved areas. The ACR is also asking for legislation that would provide clear exceptions and processes to override step therapy requirements. The ACR supports a bipartisan bill (H.R. 2077) introduced in the House in 2017 that requires employer-sponsored health plans to establish a clear and transparent way for physicians to seek exceptions to step therapy protocols for patients. The bill also establishes a reasonable and clear timeframe to override decisions and requires insurers to consider a patient’s medical history and provider’s expertise and professional judgment before delaying or denying a medical treatment.
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Calling these “two of the key asks” at the upcoming meeting, Angus B. Worthing, MD, ACR Government Affairs Committee chair, emphasized that if these legislative items get passed into law this year, “they’d go a long way to addressing our profession’s current and future needs.” The ACR will also advocate for specific legislation currently in the House that will help improve patient access to care and treatment, such as:
- Allocating $20 million annually from the Department of Defense for rheumatology-specific biomedical research for the prevention and treatment of arthritis and autoimmune diseases.
- Streamlining onerous prior authorizations. The ACR supports a bill (H.R. 4841) in the House to develop an electronic prior authorization standard for Part D and Medicare Advantage plans to streamline and reduce delays for prior authorizations; and
- Reforming the Pharmacy Benefit Manager system. The ACR supports two bills in the Senate that would prohibit gag clauses that prevent pharmacists from proactively notifying patients how to pay the lowest price possible for their medications. The Patient Right to Know Drug Prices Act applies to plans offered through exchanges, private employers and sponsors, and the Know the Lowest Price Act applies to Medicare Advantage and Part D.
Grassroots Advocacy Needed
To help the ACR in this effort, rheumatologists are encouraged to bolster the advocacy efforts in D.C. by contacting their own legislators through letters, emails, phone calls or social media. Prewritten letters that can be edited are available to ACR/ARHP members via the ACR’s Legislative Action Center.