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ACR Leads AMA Resolution on Payer Financial Incentives to Patients to Switch Treatment

From the College  |  May 22, 2021

For the June 2021 Special Meeting of the American Medical Association (AMA) House of Delegates, the ACR authored and is leading a resolution that, if passed, would have the AMA officially oppose the practice of insurance companies providing financial incentives for patients to switch treatments; support legislation that would ban these insurer policies and oppose legislation that would make these practices legal; and engage with state regulators urging review of the legality of such policies.

Several specialties have joined in cosponsoring the ACR’s resolution, including the American Academy of Dermatology, American Academy of Ophthalmology, American Gastroenterological Association and American College of Gastroenterology. The meeting will be held virtually June 11–16.

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The resolution was spurred by recent Cigna activity notifying patients on Cosentyx (secukinumab) that, due to recent plan changes, they are paying a higher copay or coinsurance and may qualify for a $500 debit card that can be used for certain health costs if they they agree to switch to a preferred alternative. The preferred alternative medications include Taltz (ixekizumab), Stelara (ustekinumab), Humira (adalimumab), Enbrel (etanercept), Skyrizi (risankizumab-rzaa), Otezla (apremilast), Tremfya (guselkumab), Cimzia (certolizumab pegol) and Xeljanz/Xeljanz XR (tofacitinib).

The ACR sent a letter to Cigna expressing opposition to this initiative, which jeopardizes patients’ health, interferes with medical decision making and undermines the doctor-patient relationship. We are also concerned that this program may disproportionately affect patients of lower socioeconomic status who have less ability to refuse such a payment, a point that is particularly salient in the current environment where the COVID-19 global pandemic has caused financial hardship for so many.

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The ACR considers and introduces resolutions at AMA meetings based on its positions and policies and the work of key ACR committees and the Board of Directors. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is both an ACR and an AMA member adds to the strength of this effort. Join or renew your AMA membership to receive valuable membership benefits as you help advance rheumatology.

The ACR’s delegation to the AMA House of Delegates consists of Gary Bryant, MD (Delegate and Delegation Chair); Eileen Moynihan, MD (Delegate); Cristina Arriens, MD (Alternate Delegate); Colin Edgerton, MD (Alternate Delegate); Luke Barre, MD (Young Physician Section representative); Christina Downey, MD (Young Physician Section representative); and Rami Diab, MD (Resident and Fellows Section representative).

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Filed under:InsuranceLegislation & Advocacy Tagged with:AMA House of Delegates (HOD)insurance

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