Rheumatology Leaders Urge Congress to Prioritize Prescription Drug Affordability, Healthcare Workforce Issues
May 12, 2022 | Advocacy
WASHINGTON, D.C. – More than 70 rheumatologists and rheumatology health professionals convened on Capitol Hill this week for the American College of Rheumatology’s (ACR) annual Advocacy Leadership Conference, where they marshaled in support of legislation that would reduce patients’ out-of-pocket drug costs and ensure America’s health care workforce is better prepared for future health care crises. Attendees included members of the ACR’s Executive Committee, Board of Directors, and other policy related committees.
“Our rheumatology advocates are fighting for policies that will meaningfully improve access, affordability, and quality of care for the nearly one in four Americans living with a rheumatic disease,” said Kenneth Saag, MD, MSc, president of the ACR. “We thank our nation’s lawmakers for meeting with us to discuss bipartisan solutions that will improve prescription drug affordability and help alleviate the rheumatology provider workforce shortage.”
As lawmakers face renewed pressure to lower drug costs, ACR advocates are urging Congress to prioritize the Help Ensure Lower Patient (HELP) Copays Act (H.R. 5801) to prohibit insurers from using “copay accumulators” to prevent manufacturer cost-sharing assistance from counting towards a patient’s deductible or out-of-pocket maximum. Insurance companies are increasingly using this tactic, which essentially allows them to profit from the cost-sharing assistance patients receive from drug manufactures, to shift more of the cost of specialty medications onto patients.
Many patients with rheumatic disease rely on expensive specialty medications to manage their symptoms. These drugs often come with high out-of-pocket costs that can be prohibitively expensive without copay assistance from manufacturers. Historically, this assistance has counted towards a patient’s insurance plan’s deductible, bringing them closer to crossing the threshold where their insurance covers the full cost of their care. Copay accumulators prevent this copay assistance from counting towards the patient’s deducible – and to the insurer’s benefit – reduces the amount the insurer must contribute towards a patient’s drug costs. The copay assistance can still be used, but when it runs out, the patient is on the hook for all of their cost-sharing until they hit their deducible or out-of-pocket maximum. A recent survey found that copay accumulators disproportionally impact the most vulnerable patients who rely on specialty medications; 69% of those who depend on manufacturer copay assistance make less than $40,000 a year and have little financial flexibility to shoulder an increase in healthcare costs.
“The HELP Copays Act would ban copay accumulators and builds on the work of 14 states who have already passed legislation prohibiting copay accumulators in state-regulated plans. It’s now time for the federal government to follow suit and prohibit this practice for all insurance plans nationwide,” said Dr. Saag.
In addition to prescription drug affordability, ACR advocates are urging lawmakers to support the Resident Physician Shortage Reduction Act (H.R. 2256/S. 834). This legislation would help build a robust pipeline of future rheumatologists by increasing the number of residency positions funded by Medicare by 14,000 slots over seven years. At least half of the additional slots added each year are required to go to specialties identified by the U.S. Health Resources & Services Administration as facing a shortage, which includes rheumatology.
There are currently fewer than 5,600 active board-certified rheumatologists available to treat 54 million Americans living with a rheumatic disease. By 2030, the demand for rheumatology care is projected to dramatically exceed supply, according to the ACR’s Rheumatology Workforce Study. This means a growing patient population is competing to see a shrinking pool of doctors, many of which are already reporting long wait times for new patients, during which time the patient’s disease continues to progress. The COVID-19 pandemic has further accelerated issues like burnout, early retirements, and career changes from the medical field, which all exacerbate the existing workforce shortage.
For additional information about the ACR’s legislative priorities, visit the key issues page.
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.