ACR releases new drug pricing and step therapy position statements

Reviewed by James Ives, M.Psych. (Editor)Apr 2 2019

The American College of Rheumatology (ACR) 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."

To make medication more affordable for patients, the ACR recommends:

• Transparency in the policies used by pharmaceutical manufacturers, pharmacy benefit managers and health insurance companies to determine prescription drug prices.
• A safe and efficient biosimilar approval pathway and marketplace that will improve access to treatment by lowering costs.
• Any comprehensive proposal that deals with rising drug prices that address these primary concerns: cost to the healthcare system, continuity of care, and out of pocket affordability to patients.

Similarly, the ACR suggests incorporating the following to improve access to appropriate treatments:

• Strategies that lower the cost of expensive therapies and oppose cost savings plans that compromise quality of care or safe clinical practices.
• The removal of step therapy, fail-first policies, or ranking of medications based solely on cost. Additionally, 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.
• Pharmacy review committees that include rheumatologists to help develop formulary benefits programs. The ACR welcomes the opportunity to provide expertise regarding rheumatic therapies to insurers.

Step therapy and drug pricing are spotlighted in the ACR's Rheumatic Disease Report Card, which shows how easy it is to live with a rheumatic disease in each state. The report card highlights adequate access to rheumatology care, the affordability of rheumatic disease care, and healthy lifestyle habits that ease the burden of rheumatic disease.

The ACR remains steadfast in its support of legislation that keeps drug pricing reasonable for those who need it most, while also protecting patient access to needed therapies that keep more than 54 million Americans with rheumatic diseases living well.