Federal Advocacy – Key Issues

Each year ACR’s Government Affairs Committee decides which issues they will take to the Hill on behalf of the ACR/ARHP membership. The ACR is active on these issues in a variety of ways including: supporting legislation, joining coalitions, writing letters, and lobbying Congress. 

Patients’ Access to Treatments / Specialty Tiers

Elimination of Tier IV Coinsurance

  • Biologic drugs like those used to treat rheumatoid arthritis, psoriatic arthritis, lupus, and other rheumatic diseases, are breakthrough treatments that often prevent disability, save and improve lives, and allow patients to function and remain in the workforce.
  • Some insurance plans are placing biologics on specialty tiers (Tier IV or higher) that require patients pay a percentage of the drug cost, often 25% - 50%, each month rather than a co-payment. Examples of typical copays are $5 for generic (Tier I), $30 for preferred brand-name (Tier II), and $60 for non-preferred brand-name drugs (Tier III).
  • These practices go against the basic premise of insurance and are causing average insured patients to underutilize necessary treatment by skipping doses, or go without their treatment entirely. There are no generics for Tier IV drugs, and annual costs can range from $12,000 -$48,000 or more.
  • In RA patients, not adhering to treatment regimens can result in permanent joint damage and disability, expensive surgeries, and higher health care costs. These practices also endanger people with serious conditions including multiple sclerosis other autoimmune diseases, Crohn’s disease, hemophilia, and types of cancer.

View ACR’s Handout on Specialty Tiers >

View ACR’s Infographic on Specialty Tiers >

Funding for Biomedical Research

Arthritis, the nation's leading cause of disability, costs the U.S. $128 billion each year.

The American College of Rheumatology strongly urges Congress to maintain current funding for federal programs engaged in vital research to combat arthritis and related rheumatic diseases. The number of people with arthritis and released diseases is projected to be 67 million by 2030.

Specifically, ACR supports $32 billion for NIH, $13 million for the CDC Arthritis Program, and $20 million for a dedicated arthritis research program at the DOD.  

Medical Research Improves the Health of Millions of Americans

Cuts to the national medical research budget deny hope to millions of patients and families struggling with rheumatic diseases. The U.S. leads the world in development of medical therapies, but budget cuts will dramatically slow down or halt progress.

Examples of federally funded projects directly benefiting patients and families suffering from rheumatic diseases:

  • NIH funding supports investigators at the University of Colorado who identified that lung inflammation is one of the earliest causes of rheumatoid arthritis. These findings are leading toward prevention of RA, a disease which leads to significant morbidity and increased mortality.
  • Thanks to NIH support, large multicenter projects including research teams in New York, Texas, California, and Massachusetts are able to study the relation to the genes of thousands of rheumatoid arthritis and lupus patients, leading to the identification of 20 genes each for each condition that will help explain the causes and lead to new treatments of these diseases.
  • NIH funding at the University of California is supporting research that has identified new ways of suppressing the immune system that will be less toxic than current methods used to treat autoimmune diseases affecting tens of thousands of people in the U.S. With federal funding, researchers identified a new genetic link to systemic sclerosis (also known as systemic scleroderma) and confirmed three previously discovered links to the disease, which can cause thickening of the skin, narrowing of blood vessels, and scarring of internal organs.

Support Biomedical Research and Our Nation's Economy

Federal funding not only supports important biomedical research in rheumatic diseases, but also provides an economic stimulus to communities nationwide in the form of jobs and customers for local businesses. NIH awards and grants alone support over 350,000 jobs across the country. With continued advancements, the economy can look forward to long term stimulation through patents, devices, and new therapies and treatments.

NIH Support is Critical for Maintaining Our Nation's Medical and Scientific Workforce

NIH career development research and training grants support young trainees in the early stages of their research careers as gain experience to become independent researchers and medical school faculty throughout the country. Workforce studies by the ACR project a large faculty shortage for training the next generation of physicians in arthritis and rheumatic disease. NIH budget cuts would impact the U.S. academic research and training environment and would be detrimental to the entire medical profession and the patient communities they serve.

View ACR’s Handout on Biomedical Research >

Other Key Issues

Repeal the Medicare Independent Payment Advisory Board

Priorities in Health Care Reform

Ensure Safe and Expedited FDA Review of Biosimilars

Create Stand-Alone Arthritis Research Program at the Department of Defense

Repeal Medicare Therapy Caps