WRA Advocacy News – June 2016

State Updates

Washington Out-of-Pocket Costs Taskforce Selected

The July 1st deadline is approaching to convene the first Out-of-Pocket Costs Taskforce meeting that was created by Senate Bill 6569 this past spring.

Joanna Lindsay from the Arthritis Foundation, and Stephanie Simpson of the Bleeding Disorders Foundation of Washington were selected to serve on the Task Force.

SB 6569 was an initiative that passed into law by a veto override vote during a special session to study the high out-of-pocket costs for patients. WRA legislative staff will continue to monitor the task force and will update WRA membership as necessary.

Patient Out-of-Pocket Costs Taskforce

Advocacy Tips: Preparing to Engage an Elected Official

As the WRA provides opportunities for advocacy, it is important that the individual advocate prepare for future engagement with policymakers. To help, the WRA government relations team has provided some helpful advocacy tips to consider:

  • DO YOUR HOMEWORK! Know exactly what you want to say and carefully review your messages.
  • If possible, compile information about the impact of specific healthcare issues on the elected officials district or state.
  • DO NOT compile a long list of statistics: your elected officials will not remember them and they will lose their impact.
  • Prepare a few dramatic numbers or anecdotes to illustrate your points.
  • To encourage policymakers to support a specific issue effecting rheumatology, present materials that clearly articulate your position.
  • Know the counter-arguments and be ready to respectfully answer any questions or disagreements.

State Roundup: Priority Legislation that Passed Around the U.S.

Washington had several pieces of priority legislation this legislative cycle that align among Rheumatology advocates around the country.  Step Therapy, Biosimilars and Prior Authorization have been at the forefront in patient access issues around the country.

  • 2016 State Priority Successes:
    • Step Therapy: Indiana, West Virginia, Illinois, Kansas, New York, Missouri.
    • Biosimilars: Kentucky, Missouri, Rhode Island, Arizona, Hawaii, Connecticut, Idaho, Oregon.
    • Prior Authorization: Ohio, New Hampshire.

Federal Updates

Part B Stakeholders Testify before Congress

Coalition of State Rheumatology Organizations (CSRO) National Advocacy Chair, Dr. Michael Schweitz, testified before the Subcommittee on Health in opposition to the recent Medicare Part B Demo proposed by CMS.

The hearing, “The Obama Administration’s Medicare Drug Experiment: The Patient and Doctor Perspective,” brought together stakeholders that would be adversely affected by the change in reimbursement for Part B drugs.

Watch the video

Bipartisan Step Therapy Letter Delivered to CMS

Congressmen Leonard Lance (R-NJ) and Scott Peters (D-CA) have sparked debate on step therapy by sending a letter to CMS. Both expressed their concerns about the barrier the adverse rule has had on patients and physicians.

The letter asks the CMS, who oversees the Medicare program, to ensure step therapy protocols are open and transparent, do not create a barrier to access and do not take prescribing power out of the hands of physicians.

Read the letter

Other Federal News Stories of Interest

Price, Shimkus, Boustany Respond to CMS’s Dismissal of Concerns Regarding the Proposed Medicare Part B Drug Payment Model

AMA Blasts Medicare Part B Drug Price Plan

Medicare’s Slavitt: MACRA Will Help Doctors, But Input Is Needed

WRA Advocacy News – April 2016

State Updates

Senate Bill 6569 (Out-of-Pocket Task Force)

SB 6569 was an initiative that passed into law by a veto override vote during a special session that adjourned in March to end the two-year legislative cycle (2015-2016). The bill creates a task force to study the high out-of-pocket costs for patients.

Task force members will be required to study the following issues associated with high out-of-pocket costs:

  • Evaluate factors contributing to the high out-of-pocket costs for patients.
  • Consider patient treatment adherence and the impacts on chronic illness and acute disease.
  • Discuss the impact when patients cannot maintain access to their prescription drugs and the implications of adverse health impacts.
  • Consider the impact of the factors on affordability of health care coverage.

Recommendations by the task force are required to be submitted to the appropriate committees by December 2016. WRA’s legislative staff will monitor scheduled task force hearings and provide updates as necessary.

Senate Bill 5935 (Biological Products)

SB 5935 authorizes a biological product to be substituted in the place of another biological product. Before allowing pharmacist to make the switch, they must adhere to the following:

  • Prescription must be marked “substitution permitted.”
  • The substitute product has to be lower than the wholesale price of the original biologic.
  • Pharmacist must notify the prescriber and inform the patient of the substitution.

The bill took effect on July 24, 2015.

Other State News Stories of Interest

M.D. Phone Home: New Legislation Expands Telemedicine in Washington
New law fights “doc-shopping” by addicts
Washington Legislature: What passed, died and was revived
State revokes, suspends licenses, certifications, registrations of health care providers

Federal Updates

Medicare Part B Sparks Opposition

Centers for Medicare and Medicaid Services (CMS) recently proposed a new payment structure for Medicare Part B drugs, leaving Rheumatologist and other physicians across the country with serious concerns about access to care for their patients. The new plan looks to reduce the reimbursement of Part B drugs from ASP + 6% to ASP +2.5% and a fixed $16.80 per day. To combat the measure, opponents have been publically engaged as over 300 groups have already sent letters urging House and Senate leadership to advise CMS to rethink their position.

WRA has been tracking the issue on an ongoing basis and will look to provide resources for rheumatologists and their practices to oppose the Part B model. WRA will also be providing comments to CMS during their open comment period which ends on May 9.

FDA Approves Biosimilar to Remicade

The U.S. Food and Drug Administration have approved Inflectra (infliximab-dyyb) for multiple indications. The biosimilar can be prescribed by a health care professional for the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, ulcerative colitis and crohn’s disease. This is the second biosimilar to be approved by the FDA.

Other Federal News Stories of Interest

The HIPAA Audits are Coming, The HIPAA Audits are Coming
Report Offers a Mixed View of Health Care Law Costs
CMS finalizes mental health and substance use disorder parity rule for Medicaid and CHIP
FDA Issues Draft Guidance for Labeling Biosimilars