ACR Members Urge Congress to Address Step Therapy Reform and Support Practitioner Loan Repayment During Virtual Hill Day Visits

WASHINGTON, DC ­– During a series of virtual meetings with federal lawmakers this week, physician and health professional advocates with the American College of Rheumatology (ACR) urged Congress to support legislation that would strengthen the rheumatology workforce and improve patient access to rheumatology care.

“More than 70 of our advocates virtually converged on Capitol Hill this week to have important discussions with their elected representatives,” said Blair Solow, MD, Chair of the ACR’s Government Affairs Committee. “With the recent release of the American Families Plan and other ambitious legislation, Congressional leaders and the Biden Administration have made a clear commitment to strengthening America’s health care system. As providers responsible for the care of more than 54 million Americans living with rheumatic disease, we believe placing reasonable limits on insurer use of step therapy and taking steps to alleviate the pediatric rheumatology workforce shortage should be part of that conversation.”

As Congress moves forward with its legislative agenda for the rest of this year, ACR advocates are encouraging lawmakers to:

• Support the bipartisan Safe Step Act (H.R. 2163, S. 464) to protect patients and place reasonable parameters around insurers’ use of step therapy. According to a recent survey, almost half of rheumatic disease patients were subject to this restrictive practice that forces patients to try and “fail” insurer-preferred medications before being able to access the treatments their provider originally prescribed. Step therapy has been shown to delay access to critical care, which can lead to severe and permanent joint and/or organ damage and even result in disability in patients who are not able to receive timely treatment. The Safe Step Act creates a clear and transparent process for patients with employer-sponsored insurance to seek exceptions to step therapy and establishes a reasonable timeframe for override decisions. Under the bill, insurers would be required to consider a patient’s medical history and the provider’s expertise before denying access to medically necessary treatment. As a federal law, the Safe Step Act is a necessary complement to recent state-level efforts to protect patients from the harmful effects of step therapy. Because most employer-sponsored health plans are regulated by a federal law known as ERISA, federal legislation is needed to address the use of step therapy in these plans. To learn more, read the ACR’s recently updated issue brief on step therapy.

• Fully fund the Pediatric Subspecialty Loan Repayment Program (PSLRP) in Fiscal Year 2022 to help alleviate the serious shortage of pediatric rheumatology providers. The PSLRP is a federal loan repayment program aimed at encouraging more pediatric providers – including specialists like rheumatologists – to serve in rural and underserved areas. Last year, Congress reauthorized the program as part of the CARES Act but did not include the suggested $50 million in funding to implement it. The United States is currently experiencing a serious rheumatology workforce shortage that is projected to worsen in future years. An estimated one million American children are currently living with a rheumatic disease – including nearly 300,000 who have juvenile arthritis ­– yet there are fewer than 400 board-certified pediatric rheumatologists in the country to treat them. Five states have only one practicing pediatric rheumatologist and nine states have none at all. As a result, many children with rheumatic diseases are being treated by a pediatrician or an adult rheumatologist who may be less familiar with the diagnosis and management of pediatric-specific rheumatologic conditions. To learn more about this issue, read the ACR’s new issue brief on the PSLRP.

“We look forward to working with lawmakers to advance legislative solutions that would improve access to care for the estimated one in four Americans currently living with a rheumatic disease,” Dr. Solow concluded. “I remain confident that these policies will help us meet the challenges ahead as our country begins to recover from the most significant public health crisis of our generation.”

Media Contact
Monica McDonald
mmcdonald@rheumatology.org
404-365-2162

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About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.