In 2005, not long after he became a private practice rheumatologist on Long Island, N.Y., Howard Blumstein, MD, dipped his toe into the advocacy pool at the encouragement of his partner, Max Hamburger, MD.
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“I thought it would be interesting to learn more about the issues that affect our patients and our practices, and I found myself drawn to [advocacy],” Dr. Blumstein says. Today, he is the outgoing chair of the ACR’s Affiliate Society Council (ASC), which helps support state and local rheumatology societies and works for the advancement of the College’s state-level advocacy goals, such as enacting step therapy and biosimilars legislation.
The Work of the ASC
Dr. Blumstein regularly works with ACR Senior Manager of State Affairs Hayley McCloud and rheumatology leaders from across the country to help coordinate advocacy and lobbying efforts in all 50 states and the U.S. territories. For example, in Dr. Blumstein’s home state of New York, rheumatology leaders and their partner organizagions advocated for the passage of step therapy legislation (signed into law in January 2017) and biosimilars legislation (which is waiting on the governor’s signature).
Dr. Blumstein recently gave a presentation on biosimilars legislation with Ms. McCloud at a lobbying day in Albany, N.Y., held by the New York Rheumatology Society, the Arthritis Foundation and the ACR. The biosimilars legislation, S.4788 and A.7509, will require pharmacies to notify patients and providers when a prescribed biologic has been substituted with a more affordable biosimilar.
“As a physician, if my patient is on a medication and they have a problem with it, I want to know what they’re on, because if I don’t, that could potentially be harmful to the patient,” says Dr. Blumstein. When patients and providers work together, it has a tremendous impact.
Along with others, Dr. Blumstein played an instrumental role in the advocacy efforts leading to the successful passage of New York’s step therapy reform legislation, S.3419C. Before the bill was passed, one of Dr. Blumstein’s patients changed insurers. Her new insurer has a step therapy protocol that would have forced her off a medication that was working to try one she had previously failed. “The insurer was mandating she refail at the old therapy over the course of six months before she could go back to the effective one,” Dr. Blumstein says. He helped her share her story with a local health-focused news outlet to better highlight this not uncommon problem. Additionally, Dr. Blumstein and his staff were able to assist in getting the insurer’s decision reversed.
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.
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.