This year, the American Medical Association (AMA) convened its annual House of Delegates (HOD) meeting June 8–12 in Chicago to discuss emerging and public health issues. Among the many policies and practices discussed: two resolutions put forth by the ACR on behalf of ACR and ARP members, one concerning prior authorization and another concerning step therapy.
Resolution Overview
The ACR and its partner societies sought support for exclusions from prior authorization requirements that delay patient care and increase administrative burden on physicians. They also sought expansion of patient protections with regard to step therapy, arguing the Centers for Medicare & Medicaid Services has not yet done enough to protect patient access to life-saving drugs. Current regulatory guidances and proposed rules allow Medicare Advantage plans to use step therapy for Part B drugs, and leave many patients unprotected in 2019 due to timing.
The Resolutions
1. Selective Application of Prior Authorization
2. Medicare Advantage Step Therapy
With the support of resolution co-sponsors—the American Society of Clinical Oncology, American Association of Clinical Endocrinologists and American Academy of Ophthalmology, as well as other specialty societies that testified—the ACR successfully persuaded the AMA to add to its policy detailed patient protections with regard to step therapy in Medicare Advantage plans. This resolution will also result in AMA advocacy, with the Centers for Medicare and Medicaid Services (CMS) implementing patient protections for 2019 and beyond, when the policy allowing Medicare Advantage plans to use step therapy protocols is not rescinded.
Additionally, the ACR received strong supportive testimony for its prior authorization resolution that would explicitly lay out, in AMA policy, support for exceptions to prior authorization—including, for example, if evidence-based guidelines from a national specialty society are being followed, or when the order or prescription is routinely approved. The resolution resulted in reaffirmation of AMA policy on prior authorization, which currently directs readers to 21 Prior Authorization and Utilization Management Reform Principles. The ACR was an original member of the coalition that developed the principles and contributed to ideas in the document. Reaffirmation of prior authorization policy means that the policies will remain viable, and robust AMA work on prior authorization reform will continue.
Note: Watch for full review of all the action at the AMA HOD Annual Meeting in forthcoming communications.
A Word of Thanks
The ACR thanks its delegation to the AMA HOD: Gary Bryant, MD (chair); Eileen Moynihan, MD; Colin Edgerton, MD; and Cristina Arriens, MD. Action on behalf of the ACR/ARP membership is based on policies and guidance developed by ACR committee volunteers and approved by the Board of Directors.
Join the AMA or Renew Your Membership Now
The ACR can represent rheumatology and bring members’ concerns and issues to the AMA only because ACR members join or renew memberships in the AMA. You can make a difference and help these efforts by renewing your AMA membership or joining today so rheumatology can continue to have a strong voice in the HOD.
