The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Step Therapy, Biosimilars among ACR’s 2017 State-Level Priorities

Step Therapy, Biosimilars among ACR’s 2017 State-Level Priorities

January 17, 2017 • By Kelly Tyrrell

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Opportunities and challenges will continue to face the rheumatology community in 2017. In response to these challenges, the ACR has outlined its federal– and state-level legislative and regulatory healthcare priorities for the year.

You Might Also Like
  • The ACR’s Advocacy at State Legislature Level in 2016 Focuses on Biosimilars, Step Therapy
  • The ACR and Partners Help Get Legislation Passed in New York to Limit Step Therapy
  • ACR Advocacy at the State Level in 2016
Also By This Author
  • Advocates on the Hill

Howard Blumstein, MD, chair of the ACR Affiliate Society Council, says that achieving at least some of these priorities at the state level will mean continuing to strengthen state societies and physician representation in state capitols around the country.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

“As we head into the next executive regime, it’s likely states will have more of a say, so I think it will be more important to have strong societies and rheumatologists willing to advocate for our patients,” Dr. Blumstein says.

4 Key Areas
Following extensive discussion, which culminates in the recommendation of a policy framework to the ACR Board of Directors, members of the ACR’s Government Affairs Committee (GAC) identified four key areas for state-level efforts this year:

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE
  1. Reducing the use and impact of step therapy formulary practices by all payers;
  2. Streamlining prior authorization processes and forms;
  3. Eliminating specialty drug cost tiering by all payers; and
  4. Supporting a biosimilars marketplace that provides protection from inappropriate substitution practices and forced switching.

Step therapy
With respect to step therapy—in which insurers require patients to first try and fail one therapy before they can try another—Dr. Blumstein says the ACR would like to see “barriers removed” to reduce or eliminate “inappropriate” medication switching.

According to the National Psoriasis Foundation, a number of states have enacted or are considering legislation to address it. This includes New York, Dr. Blumstein says, where Gov. Cuomo signed step therapy legislation on Dec. 31, 2016.

“This culminates the efforts of numerous patient organizations, such as the Lupus and Allied Diseases Association, Lupus Foundation, Arthritis Foundation, and National Psoriasis Foundation, along with physician organizations like state rheumatology societies and the ACR,” says Dr. Blumstein. “This is the perfect example of the types of partnerships that are needed for success.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Prior authorization
Prior authorization can be streamlined through a universal approach, Dr. Blumstein says, providing “a very clear pathway to approval for patients” that would be “less cumbersome” for staff.

Specialty tiers
Regarding specialty tiers, The Commonwealth Fund recently highlighted the fact that insurers have shifted the cost of drugs onto consumers as prices have risen.1 Several states and the District of Columbia have acted to limit the burden on patients. New York has eliminated specialty tiers altogether. The ACR is working to support legislation in other states, says Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee (GAC).

Pages: 1 2 | Single Page

Filed Under: Legislation & Advocacy, Professional Topics Tagged With: Biosimilars, prior authorization, specialty tiering, state-level priorities, step therapy

You Might Also Like:
  • The ACR’s Advocacy at State Legislature Level in 2016 Focuses on Biosimilars, Step Therapy
  • The ACR and Partners Help Get Legislation Passed in New York to Limit Step Therapy
  • ACR Advocacy at the State Level in 2016
  • State Step Therapy Laws: Not All Are Created Equal

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.