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.
Support for the model legislation is not universal. The California Health Benefits Review Program (CHBRP) presented an opposition to the model language, along with a veto letter from California Gov. Gavin Newsom. Both detail the potential increased costs of the proposal and estimate that the legislation could require coverage for more than 500 tests that are not currently supported by clinical guidelines. Gov. Newsom’s letter asserted that tests supported by clinical evidence are already covered by California health plans.
The consideration of biomarker testing model legislation is especially timely. A number of states are considering legislation this session. NCOIL is scheduled to vote on the model language at its summer meeting in July. As states continue to take up this issue, NCOIL’s model will have a great deal of influence moving into the next legislative year if it is ultimately approved.
Hospital Price Transparency
The pricing transparency movement is beginning to move beyond just PBMs. In Florida, Gov. Ron Desantis’ proposed drug pricing legislation is taking aim at manufacturer pricing transparency. In another expansion of price transparency, the Health Insurance and Long-term Care Issues Committee discussed draft language of NCOIL’s proposed hospital price transparency model.
The model bill would require hospitals to maintain a price list for standard fees, such as supplies, procedures, room and board and facility fees. The idea behind this model bill is to promote competition among facilities to lower costs and fees. Although the model language limits these reporting requirements to hospitals, we will closely monitor state legislation to see if there are efforts for those requirements to expand beyond hospitals. Although there will likely be very little impact on rheumatology from this model bill, it is important to be aware of these efforts because they may eventually creep over to impact other clinics and facilities.
This model legislation will also be eligible for approval at NCOIL’s summer meeting. The ACR will continue to watch this and other transparency issues moving forward to ensure they do not negatively impact our members.
The issues considered at the spring meeting underscore the importance of the ACR’s partnership with NCOIL. NCOIL is a unique and bipartisan organization that gives the ACR the opportunity to discuss health policy solutions in the early stages of development. Having the provider voice represented at this forum is invaluable, and the ACR appreciates the opportunity to work with and support the work of NCOIL. To learn more, you can access most of the meeting presentations online.
Joseph Cantrell, JD, is the director of state affairs and community relations for the ACR.