Rheumatologists and rheumatology health professionals convened on Capitol Hill late last week to urge legislative action on policy issues affecting rheumatology care during the American College of Rheumatology's Advocacy Leadership Conference in Washington, D.C.
Noting the rising costs and increasing access barriers in rheumatologic care, specialists encouraged lawmakers to support legislation that would create reasonable exceptions to the use of step therapy, grow the rheumatology workforce, increase transparency in drug pricing, and hold pharmacy benefit managers accountable for pricing practices that increase out-of-pocket costs for patients.
Pricing transparency and consumer costs are becoming increasingly important across the healthcare ecosystem. Last week, the Centers for Medicare and Medicaid Services proposed a transparency rule that many said will cause confusion among patients because charges often have more to do with diagnostic related groups (DRGs) than the retail price. That was two days after CSM Administrator announced the agency's drug dashboard to ultimately reduce the price of medications.
This week, ACR President David Daikh, MD, said in a statement that rheumatology care is at a critical juncture.
"According to the latest federal estimates," Daikh said, "as many as 54 million Americans have a doctor-diagnosed rheumatic disease, and a recent academic study suggests that number could be as high as 91 million when taking into account symptoms reported by undiagnosed individuals."
Daikh added that the rheumatology workforce isn't growing fast enough to keep up with demand, making it difficult for patients to access and afford the latest therapies.
The ACR threw its support behind several pieces of legislation, including the Know the Lowest Price Act of 2018 and the Patient Right to Know Drug Prices Act, bipartisan items that would allow pharmacists to inform patients when the cash price of their medicines is lower than the price they would pay with insurance coverage; and the Prescription Transparency Act of 2018, which would allow pharmacists to inform patients about alternative options to lower out-of-pocket drug costs.
Also garnering the group's support was the Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018, bipartisan legislation which would require the Centers for Medicare and Medicaid Services to develop electronic prior authorization standards for Medicare Part D and Medicare Advantage plans.
Rheumatology leaders also advised members of the House and Senate Appropriations Subcommittees on Defense to establish a line item in the Congressionally Designated Medical Research Program for arthritis at the Department of Defense, using $20 million in existing funds. Such a program would meet the growing needs of active duty military personnel and veterans, a disproportionate number of whom live with osteoarthritis and other rheumatic diseases.
While ACR maintains that legislative approaches would help mitigate costs, technology is also starting to play a role in cost control in rheumatology. In November, researchers at multiple institutions in China collaborated to develop the Smart System of Disease Management, a series of applications based on clinical data working in conjunction with a system that includes online consultation through a mobile app to improve care management among rheumatic disease patients.
The research indicates that rheumatoid arthritis patients trained to use SSDM were able to perform self-management afterward, including disease activity scoring of 28 joints and health assessment questionnaire evaluations and medication and lab test data entry. The aim of the study was to evaluate the economic feasibility and medical benefits of using SSDM for online consultation with a rheumatologist.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com