Excessive Patient Cost Sharing
Insurance companies often include biologics and other novel therapies in a specialty tier, which requires substantial patient cost sharing. To remove these discriminatory barriers, the ACR has worked with the Arthritis Foundation to form the Coalition for Accessible Treatments. This coalition, which now includes 32 active members, has advanced the Patients’ Access to Treatment Act (PATA).
PATA (H.R. 1600), crafted by the ACR, limits specialty drug cost sharing (Tier IV and higher) to the plan’s level of cost sharing for non-preferred brand drugs (Tier III). The ACR was on hand and had a featured role in the reintroduction of PATA on March 25 by Rep. David McKinley (R-W.Va.) and Rep. Lois Capps (D-Calif.). Working with coalition partners, we had signed up 50 co-sponsors at the time of introduction, with the goal of getting more than 140 co-sponsors on board. We are now working to put forward a comparable bill in the Senate.
Making the Next Big Discoveries Possible
We must also ensure the discovery of the next breakthrough treatments through a robust portfolio of basic and clinical research. Despite unprecedented scientific opportunities, investigators face an enormously challenging funding environment. The NIH once funded one in three grant proposals, but now funds only one in six. We are not only leaving many innovative projects in the drawer, but are also putting ourselves at risk of losing this generation of young scientists because of the uncertain funding climate.
The ACR supports an NIH funding level of at least $32 billion in FY 2016. We have joined other supporters of medical research in advocating for this level of funding and will continue to work with appropriators in the House and Senate to achieve funding that keeps pace with needs and biomedical inflation. The ACR is also working to advance legislation that would allow NIH funding to surpass caps put in place by the Budget Control Act, as well as bills that would provide for more sustainable funding outside of the annual appropriations process.
Although I have mentioned only a few of the major advocacy initiatives, the Government Affairs Committee has, in fact, identified more than two dozen major issues affecting rheumatology practices and our patients. Sequester cuts, biosimilars, step therapy, complex chemotherapy codes, more appropriate reimbursement of rheumatologists’ care, pediatric access and many other issues are also areas in which the ACR is advocating at the federal and state levels. The ACR Insurance Subcommittee and the Practice Advocacy division are also actively working with insurers on your behalf.
