At their state capitol in Tallahassee on March 28, seven board members of the Florida Society of Rheumatology (FSR) lobbied to support legislation regarding prior authorization, step therapy and non-medical switching. They also educated lawmakers about rheumatic diseases and how access to the right therapy may dramatically improve patients’ lives.
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“We talked about the problems encountered when step therapy is not appropriate for a patient and followed this with case studies. We talked about our patients and what kind of diseases they have. We explained that before biologic drugs were available, about half of rheumatoid arthritis patients were disabled within 10 years,” says FSR President Robert W. Levin, MD, a practicing rheumatologist in Clearwater, Fla. “We told them what the pharmacy benefit managers [PBMs] have done to usurp our primary role to guide our patients to the best therapy for their diseases. The current rebate system has allowed the PBMs to essentially practice medicine without a license.”
2 Key Issues
In Florida, bills must pass simultaneously in both houses of the legislature, says Dr. Levin. The FSR supports the Health Insurance Authorization bills (HB 877/SB 530), which would add transparency to prior authorization and step therapy processes that control fail-first protocols and require insurers to give policy holders and providers advance notice on protocol changes. “It would give us the option to sidestep step therapy when it’s not appropriate for a patient,” says Dr. Levin.
They also lobbied for the Consumer Protection from Nonmedical Changes to Prescription Drug Formularies bills (HB 95/SB 182), which would restrict health benefit plans from changing formularies in the middle of contracts, as well as restrict the subtraction of drugs from formularies. “This bill would force the insurer to keep the same drugs on the formulary for the whole insurance year.”
A Political Force
“Politically, we want to become a force to shape our own legislative agenda in Florida. It’s important to drive legislation on our issues as rheumatologists,” Dr. Levin says. “We learned the hard way that we needed to have feet on the ground at the legislature. We’ve worked to address bad language in bills and to have a seat at the table when legislation is being crafted. It’s an ongoing process. We want to improve what we are able to do for our patients and reduce the hassles of practicing medicine.”
Upcoming FSR Annual Meeting
The FSR will holds its annual meeting on June 22–25 in Orlando. More than 200 rheumatologists and 350 total attendees are expected, says Dr. Levin. Attendees can earn up to 14 continuing medical education hours, and topics include integrative rheumatology, evidence-based vasculitis treatment, as well as tips for success in the new Merit-Based Incentive Payment Systems (MIPS). There is also a track for office managers.
“We’re fortunate to be able to provide what we do for our membership, including services that are truly state specific,” says Dr. Levin.
Susan Bernstein is a freelance journalist based in Atlanta.