Step therapy, also known as “fail first,” is a tool used by insurers that requires patients to try a less expensive treatment, or series of treatments, before they can access the drug originally prescribed by their physician. Overly burdensome step therapy requirements can jeopardize the patient-provider relationship and unnecessarily prolong ineffective treatment, preventing patients from immediately starting, or in some cases continuing, to access the most appropriate treatment recommended by their doctor. Continue reading Importance of Step Therapy Reform
On Wednesday, January 23, a group of Georgia Advocates gathered at the state capitol building to talk to legislators about step therapy reform. The event was attended by Advocates from across the state,including a mother and daughter who drove from three hours away to talk about the challenges they’ve faced getting access to their medications. The day included a visit from the bill sponsor, Rep. Sharon Cooper (R-43), a brief overview of current step therapy practices and role playing, as well as meetings with some of Georgia’s legislators.
Our Advocates talked to legislators about step therapy, which is an insurance practice that requires patients to use a lower-cost drug before permitting more expensive treatments, despite a physician’s recommendation. Rep. Cooper shared with our Advocates that her bill will create guardrails, allowing a physician to override a step therapy request if the requested medication will negatively react with a medication the patient is already taking, or if the patient has previously tried and failed that drug.
The bill has just been introduced and will go through the Georgia House and Senate chambers for review and votes. Please take a moment to take action by reaching out to your legislators and asking them to support step therapy reform in Georgia.
Living with arthritis can be a daily struggle. Your quality of health and life will be affected by how much you speak up for yourself. Here are some ways to be an effective self-advocate. Continue reading 5 Ways to Advocate for Yourself
It’s Never Too Early to Think About Open Enrollment
We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs, pharmacist gag orders, President Trump’s drug pricing blueprint, drug rebates, premium increases, and an update on the Affordable Care Act.
On Wednesday, December 20, Congress passed the Tax Cuts and Jobs Act (TCJA). There were several health-related changes included in the legislation, such as a repeal of the Affordable Care Act’s individual mandate, and changes to the medical expenditure tax deduction. Below we explain the key health provisions that made it into the final law, how it may impact you, and what’s next.
Let’s start with the individual mandate.
Continue reading Answering Your Questions About the New Tax Reform Legislation
Recently, the Arthritis Foundation lead the charge in the passage of three new laws in the state of California that will ensure patient care and continue to keep prescription costs low. The laws focused on issues dealing with Biosimilar Substitution, Step Therapy, and controlling out-of-pocket costs for residents of California.
With specific regard to the new legislation regulating the step therapy process, Krystin Herr, vice president of government affairs and advocacy in the pacific region for the Arthritis Foundation, stated, “Many patients with complex chronic conditions, such as rheumatoid arthritis, do not always fit a ‘one size fits all’ approach to medication. However, step therapy protocols do not reflect that.”
For those living with arthritis and those fighting to conquer it, there are no shortage of barriers, bottlenecks and even days where No becomes the norm. As part of our efforts to fully support the arthritis community and break down those barriers to achieve more moments of Yes, we fight on many levels, including legislative, to make real change that impacts the lives of the over 50 million people living with this disease. Today, we celebrate a big victory for the 5.9 million people (38,000 of whom are children) in California living with arthritis.
The law creates a pathway for the introduction and use of biosimilars into the mainstream marketplace. Biosimilar medications have the potential to provide safe and effective treatment to people with arthritis at a potentially lower cost than name-brand biologic medications.
Biologics are carefully engineered, and they can never truly be duplicated. This means that even biosimilars deemed interchangeable are not generic replicas of original biologics. Nationwide, states are now enacting legislation to create a pathway for biosimilars because current laws on generic substitution do not have jurisdiction on biosimilars.
Thanks to the efforts of Arthritis Foundation Advocates, an amendment that could cut vital arthritis research in the Senate Defense Authorization bill will not go to the floor of the Senate for a vote! Over 58 letters and phone calls were made to senators last week by Arthritis Foundation Advocates to preserve the research program. Last week, Sen. John McCain (R-AZ) filed an amendment to the National Defense Authorization Act asking that all research not directly related to deployment, combat, recovery and rehabilitation be defunded. The amendment could have cut some of the arthritis research currently being conducted by the Department of Defense, and made researchers more cautious in the type of research they pursue. Even research that gets funded would have had to go through extra hoops to ensure it is related to specific military functions.