Advocacy in Washington, D.C.
Washington, D.C. is home to 101,000 citizens living with doctor-diagnosed arthritis. Over half of these D.C. residents have work limitations due to their conditions. Advocate to eliminate barriers of care for those living in our city with arthritis by joining the Arthritis Foundation’s
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D.C. citizens have activity
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State Fact Sheet
Find out how arthritis affects people in Washington D.C. and what you can do to make a difference
State of Your Health
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. Please be sure to view our Washington D.C. Department of Insurance fact sheet that gives instructions on how to appeal, request an external review or file a complaint with your insurance commissioner.
New Law: Out of Pocket Cost Reform in Washington, DC
What are out of pocket costs?
Insurers often place expensive drugs like biologics on specialty tiers, requiring you to pay a percentage of the cost (sometimes as much as 50 percent) rather than a fixed-dollar copay. This can cause a patient to reach their annual out-of-pocket spending cap in the first few months of the plan year, a significant financial burden for many patients.
How does this new law address step therapy in Washington DC?
In 2017, Washington DC passed legislation to address out of pocket cap costs and the law went into effect in 2018. This new law caps specialty drug copayment or co-insurance out-of-pocket costs to no more than $150 for up to a 30-day supply, or $300 for a 90-day supply
Which patients will benefit from this new law?
This law will decrease out of pocket cost to patient and gives patient right to request a non-preferred drug to be covered under the same cost sharing applicable to preferred drugs if physician determines that preferred drug would not be as effective or would have adverse effects or both. To learn if you are covered, contact your insurer and provide your policy number.
What should I do if I experience this barrier to care in Washington DC?
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Department of Insurance one pager, click here to learn more.
Share Your Story
You are the expert of your own experience with arthritis. Share your story with us today!
Advocate for What's Right
As an Arthritis Advocate, you’ll feel good about taking action to make health care more accessible. Help shift the policy and public perception that affects those living with arthritis.