Arthritis Foundation Legislative Position Statements

Our Legislative Position Statements

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The Affordable Care Act creates 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. The Arthritis Foundation supports legislation that provides a pathway for biosimilar substitution.

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Formulary Transparency

Most health insurance plans have a website that allows consumers to compare the costs and benefits of healthcare coverage, but they don't include specific information for those with arthritis (e.g. cost sharing, prior authorization or step therapy requirements). The Arthritis Foundation supports legislation that provides formulary transparency in health insurance plans. Read our formulary transparency legislative statement to learn more.

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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. The Arthritis Foundation supports legislation or regulation that restricts narrow or inadequate network providers.

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Out-Of-Pocket 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 chronic diseases, monthly medication costs can include several kinds of medications, which are often charged at specialty tier costs. The Arthritis Foundation supports legislation that limits out-of-pocket costs.

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Prior Authorization

Many insurance companies require a lengthy prior authorization process before dispensing specialty drugs. Each insurance plan has its own system of forms, protocols and approval procedures in order to complete this process, which often cause unforeseen delays, restricting access to essential patient care. The Arthritis Foundation supports legislation to standardize prior authorization protocols and streamline access to vital medications.

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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. The Arthritis Foundation supports legislation that provides limitations on step therapy/fail first protocols. Read our step therapy legislative position to learn more.