With a number of new legislators and new governors sworn in this month, 2019 promises to be an exciting year for state-level rheumatology advocacy.
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“Now is the time to reach out and share our top issues with new legislators in your state,” suggests Joseph Cantrell, ACR senior manager of state affairs.
ACR Affiliate Society Council Chair Christopher Adams, MD, FACP, FACR, works with Mr. Cantrell to support state rheumatology societies in working with legislators to promote policies that enhance rheumatology care for providers and patients. Mr. Cantrell and Dr. Adams shared five key legislative priority areas the ACR will be supporting at the state level in the year ahead.
- Pharmacy benefit manager (PBM) reform—The ACR will continue to raise awareness about the role PBMs play in drug pricing, and promote legislation that increases transparency of PBM practices and provides more oversight of PBMs by state governments.
“We expect to see many states introduce PBM legislation, with more states moving to bring PBMs under the regulatory authority of the insurance commissioner,” Mr. Cantrell says.
“The ACR is also closely watching the legislation passed in Arkansas last year as a potential solution to the challenges we face when dealing with the tangled relationships of PBMs and their role in drug pricing,” Dr. Adams says. “We have made some inroads working with other advocacy groups, but more needs to be done to help state legislators understand how important it is to regulate the current system, which has led to unsustainable price increases in pharmaceutical treatments we use.”
- Step therapy and prior authorization—The ACR will work to make sure laws addressing these issues are written to enhance patient access and decrease the administrative burdens for physicians. Where laws have already been enacted, the ACR will evaluate their effectiveness and try to fix statutes where needed.
Rheumatologists need to use best-evidence comparisons between treatment options to advocate for inclusion of more than one mechanism of action as a first step, Dr. Adams suggests. “In my state of Alabama, I have a choice of three drugs as initial therapy for rheumatoid arthritis, but they are all TNF-alpha inhibitors. On the other hand, for psoriatic arthritis, I have a choice of three drugs with differing mechanisms of action. This does not make sense. The best we can do is ensure rapid and effective approval of alternatives when appropriate.”
- Workforce initiatives—The ACR is committed to developing policy solutions to address the workforce shortage in rheumatology. Workforce shortages create access barriers for patients. This significantly impacts rural areas where patients can struggle to find convenient care options.
“The ACR will be having introductory discussions with legislators about workforce initiatives to support rheumatologists,” Mr. Cantrell explains. “We will look for any workforce bills where rheumatology can be added without having to introduce separate legislation.”
“The rheumatology shortage is as much a challenge with geographic maldistribution as it is a challenge with absolute numbers,” Dr. Adams says. “We must institute programs immediately that will allow expansion of the number of fellows in training, but at the same time we must work at a federal and state level to create incentives for newly trained rheumatologists to locate to underserved areas.”
- Biosimilar substitution—The ACR will continue to advocate for responsible biosimilar substitution laws that protect the doctor and patient relationship by requiring communication, from the pharmacist to the physician, when substitutions are made. The ACR will also work to maintain communication requirements in states that have sunset provisions in their biosimilar substitution laws.
“We maintain that communication is key to effective biosimilar substitution, and there must be some sort of notification to tell the physician what medication the patient is actually taking,” Mr. Cantrell stresses.
- Medicaid changes—With changes in governorships and shifts in balances of power in state houses, the ACR will be watching efforts to alter or expand Medicaid very closely. The ACR will also continue to watch any waiver proposals that are submitted and will be commenting where necessary to preserve patient access to the rheumatology professionals they need.
Take an Active Role
“The single most important way to get involved is to join and be active in your local and state rheumatology societies, as well as your state medical society,” Mr. Cantrell says. He suggests getting to know your state legislators before you need them. “Go to a fundraiser, schedule an office meeting, call or write so your legislator will know you and know that you are a serious and informed constituent.”
Dr. Adams believes rheumatology professionals can advocate more effectively by learning the best practices from other states and utilizing templates for model legislation.
He also believes that patient stories can be powerful in helping legislators understand how healthcare costs and legislation impact patients. “Bringing stories of our patients who have suffered economically, because of the high cost of medicine, and medically, because of their inability to pay, can show the human cost, which legislators need to set as a balance against the business costs that insurance companies present.”
Mr. Cantrell emphasizes that advocacy does not have to be a daunting task, and he is available to give guidance and information to ACR members to help make contacts with legislators as meaningful as possible. “There is a lot happening at the state level that gets lost in the noise coming out of Washington. The more you can get yourself plugged in at the state level, the more effective your advocacy will be.”
Carina Stanton is a freelance science journalist based in Denver.