On May 12, ACR leaders representing the Board of Directors, the Affiliate Societies Council and the Committees on Government Affairs and RheumPAC took the ACR’s policy message to Capitol Hill. There is power in numbers, so we hope you will participate in your own Virtual Hill Day by visiting Legislative Action Center and letting your members of Congress know where you stand on the following issues:
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- Support H.R. 1600, the Patients’ Access to Treatments Act (PATA). Biologic therapies are breakthrough treatments that can prevent disability, save and improve lives, and allow patients to function and remain in the workforce. A growing number of insurers are placing biologics on specialty tiers (Tier IV or higher) that require patients to pay a percentage of the drug cost each month, often 25% to 50%, rather than a co-payment. Because biologics are expensive, patient co-pays for these specialty tier therapies can easily range from $500 to more than $5,000 each month.
These practices go against the basic premise of insurance and are causing average insured patients to underutilize necessary treatment by skipping doses or going without their treatment entirely. Non-adherence to medication regimens contributes $100 billion in annual direct costs to the U.S. healthcare system. More than $2 billion is lost each year in patient earnings and productivity due to non-adherence to medications.
- Support designated funding for arthritis research from the Department of Defense (DoD). Arthritis is the leading cause of disability among U.S. military veterans and the second most common reason for medical discharges from the U.S. Army. As such, the ACR has been fighting for the DoD to dedicate some of its current funding to arthritis research, and is getting close to securing $20 million in the upcoming appropriations process.
- Stop the CMS proposed Part B drug demonstration project. A new federal proposal could further cut payments for Part B drugs and have devastating effects for Medicare patients who rely on biologic therapies. Many rheumatologists have already been forced to stop prescribing biologic therapies to Medicare patients suffering from arthritis, lupus and other rheumatic diseases because the current Medicare Part B payment structure does not cover the cost of administering these complex therapies. An additional cut to payments would force more rheumatology patients to receive biologic infusions in a hospital setting, where they will be faced with higher co-payments, more expensive facility fees, potentially longer travel times and administration of complex therapies without the supervision of their rheumatologists.
The CMS proposal is based on a premise—nonexistent in rheumatology—that there are less expensive options available to rheumatology patients under Part B. As is, in rheumatology only a handful of similarly priced biologic therapies are available under Part B. There isn’t a whole host of Part B options from which rheumatologists can choose and certainly not less expensive choices available for rheumatology patients.
Please visit Legislative ActionCenter at any time to send your thoughts on these issues to your elected officials. Content for your letter is available on the site, so conduct your virtual Hill visit today!