Credit: fizkes/iStock
Credit: fizkes/iStock

Key Takeaways 

  • Federal legislation aimed at making rheumatology care more accessible is being considered.
  • The three proposed bills seek to lower the cost of medications and reduce treatment delays.

Living with a chronic illness might be many things, but easy is not one of them. Navigating a complex health care system while dealing with chronic physical pain can leave patients with feelings of despair. And yet…headway is on the horizon.

Last week, patient advocates from the American College of Rheumatology met on Capitol Hill to advance legislation aimed at making rheumatology care more accessible. As the prevalence of rheumatic illness continues to rise, with the CDC estimating that by 2040, 78 million Americans (26 percent of the population) will have doctor-diagnosed arthritis, it is important that lawmakers are educated about these policy issues.

“Coinciding with Rheumatic Disease Awareness Month, this event is an excellent opportunity for rheumatology advocates to connect with their Members of Congress and discuss the policy issues impacting patient care,” said Dr. Blair Solow, Chair of ACR’s Government Affairs Committee, in a recent press release. “We look forward to continued collaboration with lawmakers on policy solutions that increase access to rheumatology care, minimize drug costs to patients and help more of their constituents live longer, healthier lives.”

Understanding the Legislation

Below is the breakdown of the three bills:

HELP Copays Act (H.R. 5801)

At its heart, this bill is meant to make prescription medications more cost-friendly for patients. At present, depending on one’s insurance, copay assistance coupons may not count toward patients’ out-of-pocket costs. The HELP Copays Act seeks to change this by requiring insurance plans to count copay assistance toward patient cost-sharing requirements.

Corey Greenblatt, Senior Manager of Policy and Advocacy at the Global Healthy Living Foundation, explained that this bill ensures that “patients who use a copay assistance program to afford their medications are able to continue to do so while having their payments count toward their deductibles.” He continues: “In a nutshell, the bill would help patients afford their medications with the help of their assistance programs.”

Safe Step Act of 2021 (H.R. 2163/S. 464)

This measure would place restrictions on the use of step therapy in employer-sponsored health plans. Step therapy is a program that supports the use of less costly medications before more expensive medications are approved for coverage by insurance companies. Some argue that step therapy delays patient care by requiring that patients wait for authorization for drugs they might need. “The Safe Step Act gives power back to patients and their providers to make medical decisions that they believe are most appropriate for that patient,” says Greenblatt. “It gives them an ability to request exemptions to step therapy protocols.”

Insurance companies oppose step therapy reforms and the ability of patients to benefit from patient assistance programs offered by biopharmaceutical companies. They claim that such practices will increase patient insurance premiums. According to research conducted by the Global Healthy Living Foundation, this is not the case. Greenblatt elaborated that GHLF has “created an evaluation tool for patients, providers, policymakers and consumers to prove that for states that have passed legislation to protect patient assistance programs, there has not been an increase in premiums. GHLF is also developing a similar tool to evaluate the impact of step therapy reforms on health insurance premiums.”

Both the Safe Step Act and the HELP Copay Act would directly impact anyone who gets their insurance through their employer, which is most people who have private insurance.

Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018)

As its name suggests, this bill proposal was created to enhance the quality of care for American seniors using Medicare Advantage. Primarily, this legislation seeks to standardize and streamline the prior authorization process. At present, insurance plans such as Medicare Advantage require patients to obtain prior authorization for medical treatments and tests.

While prior authorization is understandably necessary to ensure quality care, the way it is facilitated often saddles providers and delays care for patients. In fact, doctors spend about 13 hours every week completing prior authorization paperwork. One of the ways this bill would ease that burden is by creating a prior authorization process that would replace the tedious faxing of documents with electronic and real-time decisions for various services.

Headway on the Horizon

Our health care landscape is far from ideal. From unreliable insurance coverage, delayed treatments, cumbersome bureaucracy, and costly medications, there is a long road ahead. And yet, let us rejoice in a bottom line full of hope.

That these three bills are bipartisan speaks to the resounding agreement across political lines that this is an area that deserves time, attention, and reform. We are inching the way toward progress, in large part due to the passion and hard work of patient advocates bringing these important issues to our nation’s leaders. The Global Healthy Living Foundation has supported these proposed bills through direct advocacy and meetings with legislators because we believe these laws would be an important step in the right direction.

Notwithstanding how important these bills are, the federal government has its own timeline. Greenblatt shared that “legislation, especially at the federal level, goes at a snail’s pace when it’s going very fast.” Given the slow pace of policy enactment, it is uncertain when the three bills may become law.

What This Means for You

Amid the challenges of living with a chronic illness, knowing that the efforts of patients like yourself are paving the way toward positive change for many others can hopefully move you toward feeling empowered. In addition, being aware of current health policy can help with self-advocacy both in the doctor’s office and with insurance companies.

Want to Get More Involved with Patient Advocacy?

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspectives and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.

American College of Rheumatology. Rheumatology Leaders and Patient Advocates Convene on Capitol Hill to Advocate for Legislation to Improve Access to Care.

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