A Man of Action
As a patient advocate, Dr. Adams has made some recent headway. Several years ago, he helped thwart the leading insurance company in Alabama from denying coverage for viscosupplementation (i.e., hyaluronic acid treatment) for arthritis patients. This year, he helped prevent the passage of a biosimilars substitution bill that he and his colleagues in the ASRD felt did not ensure adequate provider notification needed to safeguard patients.
In his upcoming role as chair, Dr. Adams plans to help empower state and local rheumatology societies through the work of the ACR’s Affiliate Society Council. One facet of this work is his plan to assist societies in developing academic and pragmatic business arguments to sway insurance companies from enacting policies that mainly boost profit margins instead of enhancing patient care.
Like all businesses, insurance companies must be profitable. However, Dr. Adams says withholding coverage for expensive drugs that make a difference in patient outcomes is “immoral.”
He continues, “My sense of fairness and dedication to patient health and well-being compels me to [do] something about this.”
Key Issues for State Advocacy
Several issues are on the current Affiliate Society Council agenda, including:
- Non-medical switching;
- Biosimilar substitution;
- Prior authorization;
- Pharmacy benefit manager practices;
- Specialty tiers; and
- Step therapy protocols.
Dr. Adams says, “It’s really easy to sit around and bellyache about things. At the end of the day, what really counts is what we can do to modify a system that we don’t like so it works better.”
Carol Patton is a freelance writer based in Las Vegas.
