The ACR’s policy is that if a switch happens, the patient should be notified within 24 hours. This year, Dr. Wallace said, the ACR helped prevent two states from creating substitution rules that require no notice at all.
On step therapy, seven states considered bills—and New Mexico passed reform—to bring policies closer in line with the ACR’s goal. Its hope is that step therapy rules will be eliminated, but when they are in effect, the aim is to allow physicians to override step therapy, based on a patient’s history, according to a reasonable timeline and in a way that’s easily accessible, Dr. Wallace said.
Among legislative victories on pharmacy benefit managers, Arkansas brought PBMs under the authority of the insurance commissioner. And in Rhode Island, ACR helped defeat legislation that would have codified copay accumulators, which prohibit manufacturer coupons from counting toward deductibles, making drugs less affordable.
Also this year, ACR introduced state rheumatic disease report cards, in which each state is graded based on access, affordability and activity and lifestyle, Dr. Wallace said. Those are available on the Simple Tasks website.
Dr. Wallace said advocating at the state level can include meetings at state capitals and in the community, along with phone, emails, letters and using social media. He put in a special word about RheumPAC, the ACR’s political action committee.
“A lot of what GAC (Government Affairs Committee) does and a lot of what the ACR does for providers and patients really wouldn’t be possible if we didn’t put our foot in the door. And the way to do that with a lot of these issues is through donations and showing these Congressmen and women that we support them, and we need them to advocate on our behalf.”
In a look at the upcoming elections, former Senator Tim Hutchinson, now a lobbyist who works on behalf of the ACR, said the midterms have been described as “the healthcare elections,” with voters ranking healthcare higher than the economy as a motivating factor in how they’ll vote.
History, he said, might be on the side of Democrats to reclaim the House of Representatives.
“If Democrats perform only at the average—since World War II on the mid-term elections in the first term of a president—though narrowly, they will gain control of the House of Representatives,” he said.
The outcome of the midterms could have effects on everything from the fate of the Affordable Care Act, Medicaid expansion and Medicare accessibility, and the coverage and marketing of opioids, he said.
