Category Archives: Policy Priorities

lori fagan arthritis ambassador spotlight

Ambassador Spotlight – Lori Fagan, Virginia

From Lori Fagan

I have been living with rheumatoid arthritis (RA) for over a decade. As a full-time working mom and wife living with a chronic condition, the last thing I need is the added strain of fighting with my health insurer.

Unfortunately, because of a common health insurance practice known as “step therapy,” the last 10 years have been a constant and stressful battle.

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advocacy biosimilars reversal

Arthritis Foundation Plays a Role in CMS Biosimilars Policy Reversal  

On Thursday, November 2, the Centers for Medicare and Medicaid Services (CMS) announced they would reverse a policy determining how providers are paid for administering biosimilar drugs under Medicare Part B. A biosimilar is a type of medication that is “similar” to a biologic reference product, approved by the Food and Drug Administration (FDA); biosimilars offer patients the promise of more affordable treatment options available on the market to address their disease.

Over the past twenty-four months, the Arthritis Foundation and other patient organizations have expressed our collective concerns with CMS’s biosimilars reimbursement policy and encouraged them to reverse it. This policy reversal is a crucial access to care victory for the arthritis community since there are two biosimilars on the market to treat arthritis. The regulatory change will foster competition and lower the cost of expensive biologic treatments, while encouraging innovation of new therapies – ultimately creating a robust marketplace of biosimilars. Read on to learn more about this important win for patients.

Continue reading Arthritis Foundation Plays a Role in CMS Biosimilars Policy Reversal  

american health care act

Answering Your Questions About the Latest Administration Actions on Health Care

On Thursday, October 12, 2017, the Administration took two actions on health care that could affect coverage for people who have health insurance through the exchanges.

President Trump signed an executive order that opens the door for the expansion of association health plans, which aren’t subject to the same level of patient protections as required by the Affordable Care Act (ACA). Second, the Administration announced the discontinuation of cost-sharing reduction payments, which are payments to health insurers that help reduce out-of-pocket costs for low income people who purchase insurance on the health exchanges.

Read on to learn more about the Administration’s actions and their potential impacts on the arthritis community.

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american health care act advocacy

Senate Health Bills Fall Short for Arthritis Community

The Senate is expected to open debate today on two bills that repeal and replace the Affordable Care Act. Tell your senator to vote no and work to write a health bill that serves patients!

Not getting health insurance because you have a pre-existing condition.

Thousands upon thousands of dollars in out-of-pocket costs every year with no end in sight.

Fear of reaching your maximum lifetime benefit because you take expensive drugs or had multiple surgeries and hospital stays.

This is what life looked like for many people before the Affordable Care Act (ACA) was passed into law in 2010. While the ACA is far from perfect, it offers critical protections like caps on annual out-of-pocket spending, a ban on lifetime coverage limits, a prohibition on pre-existing conditions exclusions and minimum essential health benefits like prescription drugs and hospitalizations.

Continue reading Senate Health Bills Fall Short for Arthritis Community

Texas Step Therapy Win

Victory in Texas – Legislation Limits Step Therapy

Exciting news in Texas! On May 23, Governor Greg Abbott signed Senate Bill 680 into law, limiting the use of step therapy. Texas now joins a growing number of states that have enacted laws that regulate the use of step therapy. With over 4 million adults and 24,900 kids with doctor-diagnosed arthritis in Texas, this is a major victory!

Step therapy is used by health insurance providers to control the order and use of prescriptions drugs. A patient could be required to try and fail lower-cost or other drugs selected by their insurance provider before coverage is granted for the drug prescribed by the patient’s treating physician. For patients, this barrier to care prevents timely access to doctor prescribed treatments and can be the difference between full mobility and joint damage.
Continue reading Victory in Texas – Legislation Limits Step Therapy

Maryland Biosimilars Advocacy

Victory for Maryland! Biosimilar Bill Signed by the Governor!

We applaud Maryland Governor Larry Hogan for joining 28 other states in creating a pathway for the substitution of biologic medications with biosimilars by signing the Pharmacists – Substitution and Dispensing of Biological Products bill into law.

Biologics are life altering drugs for people with arthritis and are very complex products made with living cells. Because of this complexity they are expensive. Biosimilars, are a new class of drugs that are similar to biologics. They have the potential to lower medication costs.
Continue reading Victory for Maryland! Biosimilar Bill Signed by the Governor!

california arthritis advocacy summit

California Advocates Work for Passage of Bill That Will Improve Continuity of Care When Insurance Carrier Changes

It’s not uncommon for patients to change their insurance carriers. Sometimes it’s by choice, perhaps because they find a carrier that better suits their needs. Other times, it might be out of their control, like when their employment changes. Regardless of why carriers are changed, should patients be required to restart the utilization management process with their new insurance carrier, essentially starting over and potentially undoing years of effective and consistent care? Continue reading California Advocates Work for Passage of Bill That Will Improve Continuity of Care When Insurance Carrier Changes

Iowa State Capitol

Victory in Iowa! Governor Branstad Signs into Law a Bill to Curb Step Therapy!

The Iowa arthritis community is celebrating Governor Branstad signing into law House File 233 on May 10, 2017.

The bill, unanimously passed by both chambers, puts limits on an insurance industry protocol known as step therapy which requires patients to try and fail medications identified by the insurance company before agreeing to cover medications prescribed by the treating physician. The bill will increase access to care for arthritis patients by limiting step therapy practices in Iowa.
Continue reading Victory in Iowa! Governor Branstad Signs into Law a Bill to Curb Step Therapy!