The new law requires insurers to base step therapy on published peer review data or appropriate clinical guidelines, and provides patients with a process to request exemption from step therapy protocols. Thus, physicians have more opportunities to ensure their patients are not forced off a medication that is working simply because they change jobs or insurers.
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A Larger Focus for Smaller Practices & Patients
Although Dr. Blumstein’s primary focus is in New York—he is the chair of the New York State Rheumatology Society ’s Government Affairs, Payer and Policy Committee and will soon become the society’s president—he is also “very interested and focused” on national legislative issues that affect the rheumatology community. For example, he regularly participates in twice-yearly advocacy “fly-ins” with the ACR.
Dr. Blumstein sees himself as an advocate for all rheumatology providers, patients and those engaged in rheumatologic research. As chair of the ASC, and through his other advocacy work, he relies on relationships with state rheumatology societies, as well as legislators and their staff, to ensure that rheumatologists have a seat at the table and patients are protected.
Dr. Blumstein believes advocacy is more than personal politics and partisanship. “These are human issues, not Republican issues or Democrat issues,” he says. “They are issues affecting all people.” He regularly encourages his friends and colleagues to get involved.
“If we are able to successfully influence policy that makes our patients better, keeps our practices healthier—if all of these interests can be aligned, we are all served well,” Dr. Blumstein says. “It just makes sense to try to do what you can. I think the biggest thing you can do is provide your expertise. We’re on the front lines.”
Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.