Key Issues

The ACR Government Affairs Committee, Affiliate Society Council, and other groups help determine which policy issues the ACR will advocate for, on both the federal and state levels, on behalf of ACR/ARP members and rheumatology patients. The ACR leads on these issues by supporting or voicing concerns regarding legislation, working in focused coalitions, authoring letters to lawmakers, lobbying Congress and state legislation, and submitting comments to regulatory agencies that implement legislation signed into law.

Federal Policy Priorities

Improve Patient Access to Quality Treatment

Reduce barriers to access:

• Prior authorization reform
• Step therapy reform
• Eliminate copay accumulator policies
• Prohibit nonmedical switching
• Establish guardrails around white bagging policies

Ensure adequate Medicare reimbursement:

• Secure adequate Medicare reimbursement related to rheumatology and cognitive specialties, including protecting evaluation and management (E/M) payment
• Prevent cuts to reimbursements in the Physician Fee Schedule (PFS) and federal statutes
• Increasing reimbursement for dual energy x-ray absorptiometry (DEXA) testing

Build the rheumatology workforce:

• Repeal the cap on Medicare funding training positions
• Adequately fund Graduate Medical Education
• Support loan repayment programs to ease the burden of medical education loans
• Ease access to the American medical workforce by international medical graduates
• Secure provider financial solvency

Drug pricing:

• Increase transparency required for pharmacy benefit manager (PBM) operations
• Ensure drug pricing reforms protect patient access to medications while reducing prices

Telehealth:

• Preserve reimbursement parity for virtual appointments with providers
• Resolve inter-state licensing issues arising from cross-border telemedicine use
• Reimburse audio-only telehealth services appropriately to preserve access
• Ensure appropriate use of in-person requirements and telehealth options
• Address disparities in access to telehealth treatment options

Research funding:

• Increase impactful NIH biomedical research and NIAMS funding
• Support targeted research funding through the Centers for Disease Control and Prevention (CDC)
• Add arthritis to the diseases receiving dedicated funding through the Department of Defense’s Congressionally Directed Medical Research Program

State Policy Priorities

Biosimilar Substitution
The ACR supports timely notification of the prescribing physician when a biosimilar is being dispensed. This preserves the doctor/patient relationship by ensuring the patient is getting the medication that the prescribing physician intended.

Prior Authorization
The ACR supports policies that enable physicians to choose the most appropriate treatment for the patient without the hindrance of excessive administrative processes for approval from insurers.

Step Therapy
The ACR opposes step therapy practices, also known as “fail-first” policies, step protocol, sequencing, or tiering. Access to treatment should be reasonable and timely without unnecessary barriers to medically necessary care.

Pharmacy Benefit Managers (PBMs)
The ACR supports efforts to increase the transparency of drug pricing practices. The ACR is working in partnership with the Alliance for Transparent & Affordable Prescriptions (ATAP) to raise awareness of the role of PBMs in drug pricing.

Non-Medical Switching
The ACR supports efforts that would allow stable patients to remain on the prescription chosen by their physician. The ACR also supports efforts that would prevent mid-year formulary changes that could force a patient to switch medication for non-medical reasons.

Co-Pay Accumulator Bans
The ACR supports bans on co-pay accumulator policies that prevent patient assistance funds from being applied to a patient’s deductible.