ALC kicked off with our regular monthly ISC meeting. It was great to finally meet my fellow committee members in person! This month, we tackled CVS Caremark’s prior authorization forms. For months, ACR leaders have been negotiating with CVS to decrease the number of questions on these forms. So far, we’ve successfully removed eight questions from the adalimumab prior authorization form. There are more to address, but it’s a start, especially given the daily burden these forms place on providers and staff.
Hill Training
After lunch, we sat down for Hill training. Committee meetings are important, but the real reason the ACR brings volunteer leaders to Washington, D.C., every year is to advocate on Capitol Hill.
I was nervous. I had seven meetings scheduled the following day, two with the Texas senators and five with Texas representatives. But what did I know about advocacy? What did I know about bills becoming laws? After all, I’m a doctor, not a politician.
The nerves were short-lived because Hill training was excellent. You may not realize this (I didn’t!), but several ACR staff members work on the Hill daily, lobbying for legislation that benefits and protects rheumatology patients and providers. But hearing from constituents—especially practicing clinicians—carries a lot of influence as legislators decide which bills become laws.
During training, ACR staff reviewed how a bill becomes a law, how election years influence the likelihood of members of Congress co-sponsoring new legislation and which bills we should discuss. Most importantly, they detailed best practices and tips for successful Hill visits. There was even a mock Hill visit session so we could see how it’s done and ask questions as needed.
This year, the ACR asked us to elicit support for two bills: the Resident Physician Shortage Reduction Act (H.R. 2256/S. 834) and the Help Ensure Lower Patient (HELP) Copays Act (H.R. 5801).
The Resident Physician Shortage Reduction Act would increase the number of Medicare-supported direct graduate medical education and indirect medical education resident and fellow training positions by 14,000 over seven years. It would specifically address the growing rheumatology workforce shortage by requiring that at least 50% of slots each year go to shortage specialty programs like rheumatology.4 It would also give special consideration to slots at hospitals emphasizing training in community-based settings, rural areas and programs with integrated rural tracks.
The HELP Copays Act would effectively ban copay accumulator programs that disallow copay assistance (e.g., pharmaceutical company copay cards) from counting towards a patient’s annual deductible and out-of-pocket maximum.5,6 The ACR has fought copay accumulator programs on the state level, and 14 states and Puerto Rico have enacted legislation that requires any payment or discount made “by or on behalf of the patient” be applied to their annual out-of-pocket cost-sharing requirement. But similar legislation on the federal level is needed to outlaw copay accumulator programs and protect patient access to the expensive but life-changing medications they need.
