AWIR political advocacy arm claims state legislative victories in step therapy, PBM reform
Click Here to Manage Email Alerts
From combatting step therapy to pharmacy benefit manager reform, the advocacy arm of the Association of Women in Rheumatology claimed several legislative victories in the past year, said presenters at the 2023 AWIR annual conference.
“It is very important that we understand how to get our money, to know about the law and to see advocacy in action ,” AWIR Vice President and advocacy Co-chair Gwenesta B. Melton, MD, a retired rheumatologist from North Carolina, told attendees.
Melton, along with Kevin Daley, vice president of state government affairs at Hart Health Strategies, a lobbying firm specializing in health care issues, Eleni Valanos, director of government relations and advocacy at Hart Health Strategies, and Stephanie Ott, MD, director of rheumatology at Fairfield Medical Center, in Ohio, discussed recent “issues, wins and opportunities” for the advocacy arm of AWIR.
“The issues that we are talking about today impact your ability to practice medicine,” Daley said. “Everything you do with your patients is impacted by some kind of policy. Getting involved is one of the most important things you can do.”
The group first outlined some of the legislative wins notched by AWIR advocates at the state level.
Legislation allowing for practitioners and patients to bypass step therapy regulations set by insurance companies passed in Colorado, Massachusetts and Pennsylvania, according to Daley.
“Not all of these laws are created equal,” he said. “But now there is a process for patients to use exceptions criteria.”
To the point that not all of the laws are the same, Melton stressed that passing a law is merely one part of advocacy.
“The passing of the bill was not as difficult as implementation,” she said.
Melton added that some states have required further legislation to better define the parameters for bypassing step therapy.
“In Ohio, the [step therapy] law was a little easier,” Ott said. “We just had to let the office of insurance know that it had been passed. Insurance is always trying to find a way around it. We just keep telling them until they fix things.”
Additional victories were scored regarding accumulator adjustment programs, which often impact patients who are receiving assistance in paying for their medications. Texas and Washington, D.C., passed laws that would improve patient access to these programs.
“We did have some more wins this year,” Daley said.
Regarding non-medical switching of medications, Daley said that “we are not seeing as much” legislation on this topic. However, a law was passed in Florida that may help reduce the impact of non-medical switching in rheumatology practice, he added.
An emerging target for advocacy pertains to “white bagging,” which is an arrangement between payers and certain pharmacies to ship a patient’s medications directly to the care site, where staff are then forced to manage and administer the medications.
“This is an issue where we are trying to insert the rheumatology voice,” Daley said.
He described white bagging as “essentially an argument between hospitals, pharmacies and pharmacy benefit managers (PBMs).” Laws regarding white bagging were passed at the state level in Texas and North Dakota.
Meanwhile, PBM reform remains a large target for advocacy, according to Valanos.
“There are bills that require PBMs to pass through the rebates they receive from the drug manufacturer to patients at the point of sale,” she said.
Fifteen states introduced such legislation in the past year, with bills being passed in Arkansas, Florida and Indiana. Valanos noted that physicians wrote in and made phone calls to support this legislation.
“There has been a lot of momentum from the states on this issue and we hope to see more,” she said.
Regarding advocacy wins at the federal level, Ott highlighted the Safe Step Act, which was approved by the Senate Health Committee and bundled in with a larger PBM reform package.
“We were very happy to see that happen,” she said.
In addition, the Help Copays Act was introduced in the Senate for the first time.
“We are raising awareness from our briefings and meetings and getting co-sponsors,” Ott said.
Senators from Colorado, Florida, Massachusetts and North Carolina participated in the bill.
None of this could have been possible without AWIR advocates, according to Ott.
“Our advocates did an amazing job to get more awareness and more support formally for the bills,” she said.
It is important to understand that AWIR’s federal and state legislative priorities can be slightly different, according to Melton. She encouraged attendees to advocate for the legislation that is most relevant to the patients and practices in their state or region.
To that point, Daley gave attendees “homework” in advocacy.
“Go to the AWIR website, and go to the action center,” he said. “The program is called Voter Voice. All you do is put your information in, it fills out a canned message that we have crafted and sends a message directly to your legislators.”
The process “takes less than a minute” to complete, according to Ott.
“It really is that easy,” she said.
Every practitioner should take some time to become involved in advocacy on some level, Melton added.
“This is an investment in your rheumatology future,” she said.
Collapse
Daley K, Melton G, Ott S, Valanos E. AWIR: Advocacy in Action. Presented at: Association of Women in Rheumatology annual conference; Aug. 10-13, 2023; Orlando, Florida (hybrid meeting).
Read more about
Click Here to Manage Email Alerts