After meeting with the ACR and other stakeholders, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Outcomes Matter Innovations (OMI) announced revisions to their Autoimmune Pathways Program.
Earlier this year, Blue Cross NC, in partnership with OMI, introduced the Autoimmune Pathways Program with the goal of reducing payer spending on specialty drugs. The initial iteration of the program would have achieved savings by paying physicians to delay the introduction of a biologic or to initiate tapering or drug holidays for patients who are in remission or show low disease activity.
The ACR expressed significant concerns about the ethics of this program and potential harm to patients’ access to treatment. After meeting with the ACR, Blue Cross NC and OMI revised the program and dropped some of the more controversial aspects, including biologic tapering and paying rheumatologists according to specific treatment decisions. Participation in the revised program is voluntary, and rheumatologists will be compensated to report results of a disease activity monitoring instrument that is endorsed by the ACR clinical practice guidelines for patients with rheumatoid or psoriatic arthritis newly started and maintained on a csDMARD.
Although the ACR is encouraged by the changes, we continue to seek clarification about patient consent and how the data will be used. The ACR will continue to advocate for fair and transparent policies that protect patients’ access to biologic therapies.
For more information or to request ACR assistance with an insurance issue, contact [email protected].
