The ACR partners with a variety of organizations with interests relevant to the support and practice of rheumatology. One partner is the National Council of Insurance Legislators (NCOIL), a legislative organization that works to educate state legislators on insurance issues, write model laws related to insurance and improve the quality of insurance regulation. The ACR is a corporate and institutional partner of NCOIL, one of only three provider groups with that distinction.
The ACR sends representatives to NCOIL meetings to participate in discussions of issues important to the practice of rheumatology. At previous meetings, the ACR has been able to contribute to conversations and model legislation on such issues as pharmacy benefit manager (PBM) and prior authorization reform. NCOIL’s spring meeting, held March 9–12 in San Diego, featured discussions of many topics important to ACR members, including PBM legislation, biomarker testing and transparency in the healthcare market. Here is a brief recap of what was discussed and the actions NCOIL will consider on these issues moving forward.
Re-Approval of PBM Model Legislation
An important outcome from the meeting is that NCOIL re-approved its PBM model legislation. This is one of NCOIL’s key pieces of model legislation in recent years and was developed with input from the ACR and our allies at the Alliance for Transparent and Affordable Prescriptions (ATAP) and the Coalition of State Rheumatology Organizations (CSRO). The model that emerged included state registration and regulation requirements for PBMs; this language was ultimately adopted as the ATAP model legislation.
NCOIL requires model legislation to be re-approved every five years, so its PBM model legislation continues to be relevant to the policy landscape. Although PBM transparency discussions have moved far beyond licensing and registration, many states still lack those basic regulatory requirements. Re-approval of this model legislation is important to encourage states that have not enacted basic reforms to take steps to establish some guardrails to protect patients and providers from abusive PBM practices.
Biomarker Testing Model Legislation
The Health Insurance and Long-term Care Issues Committee discussed draft language for NCOIL’s proposed model legislation on biomarker testing. The biomarker legislation would require state plans to cover biomarker testing after diagnosis. This would enhance the movement toward precision medicine by requiring plans to cover biomarker testing that would allow providers to identify which drugs and biologics might best treat a patient’s condition. Such testing would also allow providers to monitor biomarkers to ensure that a patient’s treatment is still optimally effective and to change prescriptions as indicated.