Understaffed, Over-Scrutinized & Feeling Powerless? ACR Advocacy Can Help

PHILADELPHIA—We all share a simple goal: taking good care of our patients. But the American healthcare system makes that difficult sometimes. Prior authorization headaches. Lack of patient access to medications for rheumatic conditions and, all too often, lack of access to a rheumatologist. The list goes on.

At ACR Convergence 2022, Elizabeth “Blair” Solow, MD, MSc, associate professor of medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, and outgoing chair of the ACR’s Government Affairs Committee (GAC), updated attendees on the top political issues affecting rheumatology in 2022 and what the ACR is doing about them. Then Angus Worthing, MD, FACP, FACR, Arthritis & Rheumatism Associates, PC, and clinical assistant professor of medicine, Georgetown University Medical Center, Washington, D.C, discussed why every one of us should advocate and how to do it. 

Top Issues

Dr. Solow kicked off her talk with an overview of the GAC’s advocacy priorities, which fall into three main buckets: 1) access to care; 2) access to medications; and 3) research funding.¹

Dr. Solow

The rheumatology community has seen progress in several arenas, including reform of strategies used by payers to contain costs, often at the expense of patient care. For example, step therapy protocols require patients to fail to respond to certain drugs before receiving approval to receive more expensive therapies, such as biologics—often regardless of clinical circumstances. Some states, including Pennsylvania and Massachusetts, have passed legislation to mitigate these protocols, and legislation to implement changes on a federal level has bipartisan support in both the House and Senate. States have also made headway on mitigating the burden of prior authorization and outlawing copay accumulator policies, and the ACR is advocating for federal changes as well.²

Drug pricing remains an issue for both new and older medications. One recent win was a provision in this summer’s Inflation Reduction Act that will allow Medicare to negotiate drug pricing in the future. “There are some caveats,” Dr. Solow said, “but I think this is an amazing first step toward lower drug pricing, especially given the current congressional environment.”

Dr. Solow also shared great news that demonstrates the impact rheumatologists can have when we raise our voices. Pharmacy benefit managers (PBMs) are an opaque problem that the Federal Trade Commission (FTC) had decided not to investigate. In response, the ACR and approximately 24,000 others sent comments to the FTC, ultimately leading to the reversal of this decision.³ “An investigation is now underway, and we’re hoping for an update on the report in 2023,” Dr. Solow said.