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Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.
As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug it is covered by Part B, but when it is used as an oral agent for rheumatoid arthritis it is covered by Part D. Early in the evolution of Part D, CMS suggested that rheumatologists writing a prescription for oral methotrexate write the words “Part D drug” on the prescription as documentation for the Part D plan.
Although CMS has instructed the plan(s) to stop requiring prior authorization for methotrexate prescriptions, this has not been resolved. The ACR continues to work to eliminate this issue, but to minimize denials it is very important for rheumatology practices to continue writing the words “Part D Drug – for Rheumatoid Arthritis” on every prescription for drugs that are sometimes covered by Part B. Keep in mind that the Part D plans are not permitted to pay for drugs that should be billed to Part B, and this statement is to inform the plans that the prescription is a valid Part D prescription.
If you are experiencing issues with a Part D plan and prior authorization requests for methotrexate, contact the ACR practice advocacy department at firstname.lastname@example.org.
The ACR invites letters of interest from those who wish to partner with the ACR to develop new clinical practice guidelines for the management of juvenile idiopathic arthritis, psoriatic arthritis and vasculitis. Letters of interest must be submitted via email by Monday, March 14, 2016.
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Around the country, a majority of the state’s legislatures have convened for the last part of their biennial sessions. In total, there are 38 legislatures that will convene by the end of January and another six will convene in February.
Legislation regarding substitution for interchangeable biologics was widespread from 2013 to 2015. In all, 30 states have introduced legislation regarding substitution of biosimilars. Of these states, 18 have adopted laws, seven have introduced legislation but failed to pass a law and five have ongoing legislation.
See below a map from the Nation Conference of State Legislatures.
The ACR’s policy on the substitution of interchangeable biologics is that the pharmacist must notify the prescriber before this substitution takes place, and if that is not possible, then notification must take place immediately (e.g., within 24 hours).
For states with “substitution of biosimilar legislation,” some type of notification for prescribers has passed, except in Florida and Massachusetts. In the majority of other states where prescriber notification has passed, notification ranges from 24 hours to five business days.
The ACR and its members continue to monitor legislation and will work with coalitions to provide comments and testimony on policy in the remaining states. The ACR most recently provided comments in a letter for Michigan House Bill 4812 for a Jan. 19, 2016 hearing. This bill allows for notification to the prescriber to be made within five business days of substitution. In a letter to the committee, the ACR requested that HB 4812’s notification language be amended to ACR’s policy of notification prior to substitution or within 24 hours.
Other issues on which the ACR state advocacy team is focusing include the following:
Prior Authorization: The ACR supports policies that enable the treating physician to choose the most appropriate treatment for the patient without the hindrance of excessive administrative processes for approval from insurers.
Specialty Tiers: The ACR supports reforming specialty tiering practices utilized by insurance carriers that result in excessive patient financial burden and greatly reduced access to medically necessary treatments.
Step Therapy: The ACR opposes step therapy practices, also known as fail-first policies, step protocol, sequencing or tiering.
The best way to advance these priorities is through your personal advocacy. Rheumatologists and rheumatology health professionals can work with their colleagues and the ACR by becoming Key Contacts and by educating their legislators on the everyday challenges you and your patients face. To ensure that you can continue to provide your patients with the treatments you believe are best, make sure you are registered to be a Key Contact. You can work with ACR staff to provide legislators with information on the effects their decisions have on patients in your state.
Patients Are an Essential Component of Grassroots Advocacy
Over the past several years, the ACR has collectively ramped up its advocacy efforts. Under the leadership of the Government Affairs Committee and with the combined advocacy efforts of many ACR/ARHP members and their patients, we made considerable progress advancing priority issues in 2015.
With the ongoing effort of ACR members and patients, we can continue to advance legislation that supports rheumatology in both chambers and have it signed into law. It takes emails, in-district visits and calls, but most importantly, it takes dedicated grassroots advocates who are willing to go the extra mile to push their elected officials.
Get Your Patients Involved
It is crucial to remember that all legislators—on the federal, state and local levels—are politicians whose continued success depends on their ability to satisfy voting constituents. Re-election, recognition and status are powerful motivators. Effective grassroots advocacy can wield as much influence over these outcomes as the biggest corporation or trade association.
The patient voice is necessary to shed some light on public health issues and increase national awareness. Patients are constituents too, and have personal stories that illustrate the issues faced every day by the rheumatology community. Their perspectives often include first-hand experiences with the challenges of accessing rheumatologic care or treatments, and can highlight the need for more research funding to keep care breakthroughs advancing.
How Can Your Patients Get Involved in the ACR’s Advocacy Efforts?
Getting involved in advocacy is a great way to influence the legislative process. Without the patient voice, delivering meaningful results would be difficult—if not impossible. Remind your patients that their voices are needed and their actions will make a difference to rheumatology.
Kelly Weselman, MD
Chair, ACR Communications and Marketing Committee