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ACR Lobbies Against Proposed Medicare Changes

American College of Rheumatology Proposal to Require Step Therapy is Detrimental to Rheumatology Patients' Interests

In a statement released last week, David Daikh, MD, PhD, president of the American College of Rheumatology, relayed the outcome of a meeting held with Health and Human Services Secretary Alex Azar on the topic of proposed changes to Medicare part B coverage of rheumatology treatment. The ACR has been concerned that a new policy allowing Medicare Advantage plans to utilize step therapy in Medicare part B would be detrimental to patients’ health and outcomes. Dr. Daikh stated: “While we support the goal of decreasing the cost of medications, the ACR has long opposed step therapy and other utilization management techniques that undermine the clinical judgement of providers, delay access to needed treatments and put our patients’ health at unnecessary risk.”

The ACR is seeking clarification from HHS on the issue of “grandfathering” with respect to Medicare Advantage plans, specifically, that policy language will state that a patient who is currently stable with their treatment will not be required to go through step therapy if they switch Medicare Advantage plans. Further, a patient who achieves remission and is able to discontinue a medication should not be forced to go through step therapy due to a subsequent disease relapse. Dr. Daikh continued, “We remain concerned that the provider burden will increase with this policy change but are encouraged by the Administration’s willingness to accept input and proposals on how to reduce burden. Further, we appreciate the Administration’s expressed willingness to engage with the provider community regarding the appeals process and the value of defining clinically appropriate treatment pathways as part of step therapy.”

Read about the ACR position.

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