- Aggressive monitoring of biologics;
- Forcing switches to their preferred biologic or biosimilar;
- Enforcing treatment tapering without provider input;
- Limiting access to FDA-approved treatments; and
- Creating unnecessary disruptions and delays in treatment.
The organizations claim to use data and real-world evidence to identify cost-effective drugs for patients. Unfortunately, third-party administrators look for the lowest-cost treatment and take away the patient-provider decision for the best treatment for the patient. Because these organizations are newer to the healthcare landscape, they are not bound to PBM-related regulations or laws. In the existing PBM regulatory framework, third-party administrators are currently regulated at a state level. However, interest has increased at the federal level, including federal legislative hearings and a review of PBM business practices by the Federal Trade Commission.
Additional Successes
The House of Delegates took action on many other topics impacting rheumatology. Significant debate and action addressed consequences of the Supreme Court’s decision to overturn Roe v. Wade. Importantly, working with others, the ACR’s delegation was able to advocate for broadening resolutions, including Resolution 223: Criminalization of Pregnancy Loss as the Result of Cancer Treatment, which initially focused on cancer care and protections for those clinicians, to pertain to all clinicians and patients. Because of these efforts, the AMA will now advocate that pregnancy loss shall not be criminalized for physicians or pregnant patients. It will also advocate that clinicians and patients should not be held civilly and/or criminally liable for pregnancy loss as a result of medically necessary care.
Additional successes were logged on resolutions to maintain access to methotrexate in the post-Dobbs era, to protect physicians practicing evidence-based medicine, and to promote state graduate medical education funding, international medical graduate and foreign medical graduate employment, among other issues impacting the rheumatology community.
Additionally, the meeting highlighted the AMA Recovery Plan for America’s Physicians, in which the AMA will focus on issues that have broad appeal across practice settings in rheumatology. Alternate Delegate Colin Edgerton, MD, noted, “The AMA is responsive to high-priority rheumatology concerns as highlighted by the AMA Recovery Plan for America’s Physicians. Chief among these priorities are fixing prior authorization and reforming Medicare payment.” Other focus areas of the AMA plan include supporting telehealth and reducing physician burnout. The ACR urges members to take action and urge Congress to avert the pending Medicare cuts by sending messages to lawmakers via the ACR Legislative Action Center.
Finally, thanks to ACR members who joined or renewed their membership in the AMA, the ACR completed a successful campaign to retain representation in the AMA House of Delegates and related critical policy bodies, including the AMA Relative Value Scale Update Committee (RUC) and AMA Current Procedural Terminology (CPT) policy groups. The ACR thanks all members who contributed to this effort. Maintain your AMA membership each year to take advantage of AMA member benefits and sustain rheumatology’s continued representation.
