The two-day conference, which featured the May 16 Hill meetings, is one of two major organized events when rheumatology leaders descend on Washington to meet with federal lawmakers. Unlike September’s Advocates for Arthritis event, this event did not include patients; instead it fell to rheumatology leaders to advocate on patients’ behalf for the following key issues.
Issue 1: Support the Safe Step Act to Counter Step Therapy
Create a clear and transparent process for many patients to get exceptions to step therapy (or fail first), require insurers to consult with patient medical histories and providers before denying medically necessary treatments, and establish a clear and reasonable timeframe for over-ride decisions. This Act would build on reforms already passed in 22 states.
Issue 2: Stabilize the Long-Term Rheumatology Workforce
Provide loan repayment for pediatric subspecialists (including in rheumatology), and address pediatric public health disparities in children’s hospitals graduate medical education programs. These initiatives would help counter a trend that shows the projected demand for rheumatologists far exceeding the supply over the next dozen years. This workforce is severely limited by the lack of substantial funding for fellowship training, while many programs rely on private funding to sustain their training. (A House bill calling for the strengthening of the pediatric workforce at large was introduced in March.)
Issue 3: Reform Prior Authorization
Improve the transparency and efficiency of this process, helping patients access care without facing delays that could jeopardize their health. Congress should require prior authorization be standardized and allow for electronic options, force insurance companies to reveal coverage restrictions levied at the point of care, and eliminate prior authorization altogether for most approved therapies.
Issue 4: Improve Access to Osteoporosis Testing in Medicare
Issue a sustainable payment for dual-energy X-ray absorptiometry (DXA) bone density scans conducted in physicians’ offices, and preserve current access to osteoporosis testing, prevention and treatment. Medicare reimbursements for DXA scans have dropped by 70% over the past decade, and active payment rates don’t cover physicians’ costs to provide this service. (A Senate bill was introduced in January and a House bill in May.)
Issue 5: Invest in Arthritis Research at the Department of Defense (DoD)
Submit an appropriations request for a dedicated $20 million line item in a DoD research program’s budget. That program lacks funding earmarked for arthritis research, despite listing similar dedicated budgets for other diseases—and despite arthritis being a major condition afflicting U.S. service members. Funding for arthritis and clinical care research overall is also significantly limited.