A recent Politico article outlined the looming agenda facing Congress as 2018 begins: Fund the government, raise the debt ceiling, modify spending caps, address healthcare subsidies, allocate additional funds for disaster relief, and address the status of millions of undocumented young immigrants.1
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Amid all that activity, the ACR, through its Government Affairs Committee (GAC) and the advocacy work of ACR/ARHP members, continues to advocate for rheumatology professionals and patients.
The ACR’s Priorities
For 2018, the ACR has a long list of legislative and regulatory priorities to address at both the federal and state levels.
Drug Prices, Access & PBM Transparency
Drug prices and access to drugs continue to be a focus of the ACR’s legislative and regulatory efforts, says Dr. Worthing. These are “probably top of the radar screen for most Americans, many members of Congress and the ACR,” he says. “It’s a multifaceted problem that is very frustrating for us in this day and age when we have the tools to diagnose and treat severe disease, and it can be heartbreaking when patients can’t access medications they’re prescribed.”
Promoting greater awareness of the role pharmacy benefit managers (PBMs) play in what patients must pay for drugs, and increased transparency of PBM practices, are among the ACR’s priority efforts in 2018 intended to address cost and access.
“Drug prices are going up in part because of the rebate system that PBMs use to negotiate with drug makers to get drugs on their formularies,” explains Dr. Worthing. “Our goals for 2018 are to start with proper definitions. We have asked Congress to have CMS properly define what a rebate is and what fees are in the system. It’s the first step toward promoting transparency; if you don’t define things first, PBMs can use a shell game to change the rebates and call it a fee.”
The Senate Health, Education, Labor and Pensions Committee has already conducted two related hearings and several committees in the House have introduced a bill to promote PBM transparency.
Without action, the cost-saving potential of biosimilars could be negated, Dr. Worthing says.
“When biosimilars come out and offer lower prices, the PBM system could derail that and prevent the very reason for biosimilars to exist from being successful,” he notes. “We are not only advocating for safe and effective biosimilars to be approved by the FDA, we are also advocating for a distribution system to get them to patients in a way that reduces prices and increases access to medications that patients need.”
Other priorities for 2018 include:
- Developing a MACRA alternative payment model (APM) appropriate for rheumatologists;
- Ensuring that any legislation on healthcare reform prioritizes affordable and meaningful health insurance coverage for children and chronically ill patients;
- Preventing inappropriate nonmedical switching;
- Addressing the rheumatology workforce shortage and maldistribution;
- Promoting insurance codes that adequately reimburse providers for cognitive care;
- Ensuring the availability of federal agency funding for rheumatology-related research;
- Promoting RISE as a tool to assist providers with MACRA;
- Streamlining prior authorization processes and forms; and
- Prioritizing bills that reform step therapy in states throughout the U.S.
How You Can Get Involved
There are a number of ways the ACR conducts its advocacy work, says Dr. Worthing, organizing “not only hundreds of meetings per year on Capitol Hill, we are also holding meetings and drafting letters and communications with coalitions of other provider and patient groups, and sending thousands of emails every year through the Legislative Action Center.”