Rheumatology has a louder voice to improve patient access to the best possible care: Advocacy at the state level.
Rheumatologists, rheumatology advocacy groups, and patients are pushing state legislatures and regulators from New York to California to dismantle barriers to care established by health plans, payers, and other stakeholders.
“We can address a lot of the issues we have with insurers and payers more effectively and efficiently at the state level,” said Gary Feldman, MD, FACR, President of the California Rheumatology Alliance (CRA) and a practicing rheumatologist in Southern California. “We have had some early success in dealing with California legislators as well as state regulators. You have more access at the state level than at the federal level, costs are much less than traveling to Washington, D.C., and a lot of state officials are more responsive to your message.”
Dr. Feldman will discuss early forays into state lobbying during the clinical symposium An Hour Well Spent: Successful Stories of Members Enhancing Patient Care Through State Advocacy on Monday from 1:00 – 2:00 pm. The symposium is also the official launch for the ACR’s new state advocacy program, Key Contacts.
“Key Contacts is a growing network of ACR members who are in or near their state capitals who can work directly with the key players in their legislatures and regulatory bodies,” said Howard Blumstein, MD, FACR, Chair of the Government Affairs Committee of the New York State Rheumatology Society and a private practice rheumatologist on Long Island. “We have missed what could have been important opportunities simply because no one was available when ACR was invited to represent our interests at the state level.”
The ACR will not scale back its advocacy work at the federal level. Because so much of health care is regulated by the states, the College has expanded an already-successful national program to the state level. The federal government handles drug approvals through the FDA, reimbursement through the Centers for Medicare and Medicaid services, coverage requirements through the Affordable Care Act, and other broad policy issues, but many of the day-to-day decisions in health care are made by individual states.
“Critical issues affecting health care access and affordability are being considered at the state level,” said ACR Senior Government Relations Specialist Starla Tanner. “Things like step therapy, prior authorization, specialty drug tiers and biosimilar substitution are being decided state by state across the country. The FDA might approve a wonderful new treatment, but if your patient has to fail on three drugs and come up with five-figure co-insurance in order to qualify for treatment, that’s a problem. This session focuses on ways to preserve and improve patients’ access to the treatment that is best for them and minimize barriers to access.”
Practical considerations, including time constraints and financial pressures faced by practicing physicians, present significant obstacles for providers to successfully advocate for their patients’ needs at the legislative and regulatory levels, Dr. Blumstein said. Health insurers and payers have more familiarity with the multiple mechanisms available to drive their agendas, have greater comfort using those mechanisms, and have the extensive resources required for success at the state and federal levels.
“Medicine is under attack from multiple sides, including rheumatology,” he said. “With some of the proposed payment mechanisms that are now in the works, rheumatology will come under increasing scrutiny from lawmakers, payers, pharma companies, health care analysts, patients, and others. We need to be prepared to respond.”
Dr. Blumstein also chairs the ACR Affiliate Society Council, which includes representatives from state and local rheumatology societies nationwide who work on issues affecting the rheumatology community at the state level.
Being prepared has already made a difference in California. The CRA, working with other medical groups, convinced the state legislature to require uniform prior authorization requirements and electronic forms, easing burdens on both patients and providers. Rheumatology is making progress on new legislation that would allow providers to determine that step therapy is not appropriate for a specific patient and move directly to first-line treatment. Another bill would ease copay and coinsurance barriers.
Legislation passed earlier this year requires prescribers to be notified within five days if a biosimilar is substituted for a branded biologic agent. The bill also addresses naming and other issues but has not yet been signed into law.
“The reality is that just being in our offices taking care of patients is not going to address access to care and a lot of the other issues we face,” Dr. Feldman said. “At this point, we, and our patients, are victims. Things are being foisted on us without us having had the input we should have had. This session will help you learn what you can do, how you can get involved, how you can get your patients involved. We have to make a difference for our patients and the state level can be a very effective place to focus our efforts.”