The ACR’s delegation to the American Medical Association (AMA) House of Delegates advanced key issues for the rheumatology community at the AMA House of Delegates Interim Meeting, held in Honolulu Nov. 12–15. Among the key outcomes were strong support for and passage of the ACR’s resolution addressing the disruptive practices of third-party pharmacy benefit administrators; successful broadening of policies supporting protection of physicians and patients from civil and criminal liabilities in a post-Dobbs landscape; and the ACR’s successful bid to retain representation for rheumatology in the AMA House of Delegates and other AMA policy bodies as part of its five-year representation review. The ACR thanks all members who contributed to this effort by joining or maintaining membership in the AMA.
Third-Party Pharmacy Benefit Administrators
On behalf of its members and the rheumatology community, the ACR is able to leverage its representation in the AMA House of Delegates by introducing for consideration new AMA policies and directives to take action. At this month’s interim meeting, the ACR’s delegation introduced Resolution 820: Third-Party Pharmacy Benefit Administrators, which shined a spotlight on the disruptive practices of these relatively new entities and advocated to bring them under existing pharmacy benefit manager (PBM) regulations, as well as future oversight efforts aimed toward PBMs.
The ACR rallied other organizations in support of its effort, and 17 other specialty societies and four state medical associations joined as cosponsors supporting the resolution: American Academy of Allergy, Asthma & Immunology, American Academy of Dermatology, American Academy of Neurology, American Academy of Ophthalmology, American College of Gastroenterology, American Society of Hematology, Association for Clinical Oncology, North American Neuro-Ophthalmology Society, American Gastroenterological Association, American Contact Dermatitis Society, American Society of Dermatopathology, American Society for Dermatologic Surgery, American College of Mohs Surgery, Florida Medical Association, Iowa Medical Society, Arizona Medical Association and Utah Medical Association.
The ACR’s resolution is now AMA policy and will direct the AMA to advocate that third-party pharmacy benefit administrators fall under the existing PBM regulatory framework and statutes, and that licensing, registration and transparency reporting should be required of these entities. It further will have the AMA advocate for third-party administrators to be included in future PBM oversight on state and federal levels.
The resolution successfully drew attention to harmful third-party administrator business practices that disregard patient health and quality of life. These third-party pharmacy benefit administrators, also considered specialty drug management organizations, operate similarly to PBMs without being referred to as such. Most currently provide and pitch their services to large employers’ self-funded plans. Their practices are highly concerning and disruptive to patient care and interfere in patient care decisions in a number of ways, including:
