The 2019–2020 legislative cycle in the states holds real hope and opportunity for critical reforms to protect rheumatology practices and patients. It is important to note that because of the state legislative process, bill passage almost always comes later in the legislative session. Although the rheumatology community has not yet seen many official wins, early movement and discussions are promising signs for the remainder of the legislative session.
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Utilization Management Reform
Utilization management reform efforts are seeing early movement in state legislatures. We are actively tracking 42 utilization management bills, and a few step therapy reform efforts seem to be the most viable at the moment.
Two states with an early promise of success are Virginia and Georgia. H.B. 2126 in Virginia has already passed out of the House of Delegates and out of the Senate Finance Committee. A potential problem for this bill: The Senate Finance Committee inserted language that would require funding in the budget for the bill to become effective. The bill sponsor, Rep. Steve Davis (R), is working to secure that funding, but this could become a poison pill for the legislation if funding is not secured.
Additionally, Georgia’s step therapy bill (H.B. 63) passed out of the House again, where it passed unanimously last year. The political dynamics in the Senate have changed, and there is renewed hope that the bill could pass the Senate this session.
Other important states to watch are Oregon, Washington, Wisconsin and Florida. It is still early in the process, but there is an increased likelihood of success, because well-organized coalitions are supporting utilization management bills in these states.
This year the ACR has taken a great leap forward in its workforce advocacy. The College has developed model language for student loan forgiveness programs for cognitive specialists who do not qualify for Health Resources and Services Administration grants. The goal of the model language is to encourage these specialists to practice in underserved areas of their respective state.
We have also secured a sponsor for a bill that is being finalized for introduction in the Georgia legislature this session. The ACR will be looking for other states that may have an interest in implementing the program to provide access to care in areas where it is currently lacking.
Drug Pricing Transparency
For the past few years the role of pharmacy benefit managers (PBMs) has been under increased scrutiny at the federal and state levels. This year, PBMs remain a popular target of legislation in many states, with 29 related bills that we are actively tracking. Most of the bills this session relate more to contract provisions, such as pharmacy claw-back provisions.
There has been a new twist in the drug pricing transparency conversation this year. Some states are now beginning to look at the practice of spread pricing, with New York leading the charge. Also, Arkansas and Louisiana are using their regulatory regimes to gather data on spread pricing practices by PBMs.
Additionally, manufacturer pricing is coming under increased scrutiny. Price-gouging bills that address manufacturer pricing practices, as well as other elements of the drug supply chain, are becoming more common. There are currently 23 price-gouging bills that we are actively tracking. There has been no significant movement on these bills yet, but as the desire to tackle drug prices grows, these bills could start garnering more attention and support.
While we expect other issues to emerge, such as non-medical switching, it is still relatively early in the legislative process since many legislatures run in two year sessions. Political fortunes in 2019 can change rapidly, so it is more important than ever for the rheumatology community to be prepared and engaged. “Success occurs when opportunity meets preparation,” so we must remain vigilant, prepared and ready to seize the opportunities that lie ahead.
You can personally help move these issues forward for your practice and patients by getting involved with your state or local rheumatology society and responding to ACR action alerts specific to your state.