People with arthritis face unique barriers to care: high costs of treatment, difficulty accessing medications, scarcity of specialists and coinsurance that limits access to treatment. Healthcare laws and policies are key factors to whether millions of Americans with arthritis get the care they need to manage their disease and live life to the fullest.
The Arthritis Foundation and its more than 144,000 volunteer Advocates regularly work with state legislators and policy makers to help identify challenges and share first-hand experiences. Together, they create a compelling lobby for the 52 million adults and 300,000 children in the U.S. with doctor-diagnosed arthritis.
Here are some key issues the Arthritis Foundation is fighting for at the state level to help people with arthritis afford medications and get the treatments they need:
Federal Priorities:
Arthritis Research: Increased federal funding for arthritis research is critical to finding better treatments and a cure for the 1 in 5 Americans and 1 in 3 military veterans with doctor-diagnosed arthritis.
Health Care Reform: Health reform replacement legislation should ensure affordability, access and coverage for people with arthritis, without exclusions for pre-existing conditions.
Congressional Arthritis Caucus: This bi-partisan group of legislators serves as a forum to raise awareness about arthritis and educate members of Congress about how to support federal and local efforts addressing arthritis.
State Priorities:
Biosimilars
The Affordable Care Act created a regulatory pathway for approving a new generation of biologic medications called “biosimilars,” which have the potential to provide safe and effective treatment to people with arthritis at a lower cost than the name-brand biologic medications. We support legislation that provides a pathway for biosimilar substitution. A biosimilars bill passed in Texas in 2015 (House Bill 751).
Out-of-Pocket Drug Costs
High cost sharing is a barrier to medication access for patients with chronic, disabling and life-threatening conditions. Because many people with arthritis also suffer from other chronic diseases, monthly medication costs can include several kinds of medications, which are often charged at specialty tier costs. We support legislation that limits out-of-pocket costs.
Step Therapy / “Fail-First”
More and more insurers are utilizing step therapy or fail first policies that require patients to try and fail one or more formulary-covered medications before providing coverage for the originally-prescribed non-formulary or non-preferred medication. We support legislation that puts limits on step therapy/fail first protocols.
Narrow Networks
Many people with arthritis who are enrolling in health insurance plans are learning that the availability of doctors, specialists and hospitals through those plans is limited, forcing those who do not have access to necessary medical care through their plans to use costly “out-of-network” providers. We support legislation or regulation that restricts narrow or inadequate networks of providers.
Increase Access to Pediatric Rheumatologists
There is a severe shortage of pediatric rheumatologists in the United States, with fewer than 350 board-certified, practicing pediatric rheumatologists, primarily clustered in and around large cities. In fact, 11 states do not have a single board-certified, practicing pediatric rheumatologist, and 7 states have only one. The Arthritis Foundation urges Congress to cosponsor H.R.1859 and S.2782 to help alleviate this severe shortage and ensure the 300,000 kids with juvenile arthritis have access to care.
To learn more about the work of the Arthritis Foundation, the scientific research being funded and information on the disease, please visit www.arthritis.org. If you would like to get involved with the Houston Arthritis Foundation by joining us as a volunteer or participating in an upcoming event, please contact Jen Torres, Executive Director, at jtorres@arthritis.org