Tuesday, 16 Jul 2019

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ACR Position Statements on Drug Pricing and Step Therapy

The American College of Rheumatology Committee on Rheumatologic Care has released new drug pricing and step therapy position statements that they hope legislators will consider as they continue to explore policy and regulatory options to make drugs more affordable and accessible.  

“We continue to emphasize these topics because they are so critical to the well-being of millions of Americans living with rheumatic diseases, some of which can be quite debilitating and even lead to death,” said Colin Edgerton, MD, a rheumatologist at Low Country Rheumatology in South Carolina and chair of the ACR’s Committee on Rheumatologic Care. “The need for patients to have access to prompt, affordable, and medically necessary treatments is ongoing and should be considered at every step of the policy making process.”

Drug Pricing

  1. All patients should have safe, convenient and affordable access to rheumatology treatments that control disease activity and prevent permanent joint and organ damage, thereby limiting disability and early death.
  2. The ACR supports rational policies that mitigate rapid escalations in pricing of rheumatologic drugs.
  3. Transparency should be encouraged in the policies used by pharmaceutical manufacturers, pharmacy benefit managers and health insurance companies to determine prescription drug prices.
  4. The ACR believes that a safe and efficient biosimilar approval pathway and marketplace will improve access to treatment by lowering costs.
  5. Any comprehensive proposal to deal with rising drug prices must simultaneously address these primary concerns: cost to the healthcare system, continuity of care, and out of pocket affordability to patients.
  6. The ACR support preserving patient access to physician-administered drugs by recognizing the rheumatologists’ role in providing specialized, continuous care.

Step Therapy

  1. The American College of Rheumatology (ACR) supports strategies for lowering the cost of expensive therapies but opposes cost savings plans that compromise quality of care or safe clinical practices.
  2. The ACR does not support step therapy, fail-first policies or tiering of medications based solely on cost.
  3. Access to medically necessary treatment should be timely and not impeded or delayed by unnecessary barriers.
  4. All healthcare stakeholders deserve transparency in formulary decision making processes.
  5. Pharmacy review committees should involve rheumatologists when developing formulary benefits programs. The ACR welcomes the opportunity to provide expertise regarding rheumatic therapies to insurers.
  6. Non-medical switching between branded products and across therapeutic classes in a medically stable patient solely for cost savings and without the consent of the patient and his/her provider is inappropriate and potentially harmful to patients' health.
Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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