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.”