Your Coverage & Care
Your Coverage & Care
 
Paying for Care

Getting Access to Arthritis Care: What Your Elected Officials – and You -- Can Do

Arthritis medications can relieve symptoms, control the disease and prevent joint damage and disability. But the rising cost of these drugs and common insurance practices may put them out of reach for many – even those who have health insurance. 

Through the work of elected officials and arthritis advocates, at least 10 states have laws limiting one more of these practices:  

  • Prior authorization – a decision by an insurer that a service, drug, procedure or durable medical equipment is medically necessary. The health plan may require prior approval for certain services before you receive them, except in an emergency.  
  • Step therapy – a practice that requires a patient to try lower-cost medications before the insurer approves the use of more expensive treatments, even when the doctor wants to prescribe them.
  • Specialty tiers – a category of drugs within an insurer’s formulary that requires a patient to pay a larger share of the cost than for generic, preferred brand or non-preferred drugs in the plan’s formulary.

Other medication access and affordability initiatives are ongoing, and more work needs to be done.  

What You Can Do

  • Know the laws of your state.  Visit the Arthritis Foundation’s State of Your Health to learn about the newest state laws. For specific concerns about state insurance laws or your plan’s adherence to them, contact your state insurance commissioner.  Not all plans – including Medicare and Medicaid – fall within a state insurance commissioner’s authority.
  • Learn about pending legislation. Visit the Arthritis Foundation’s Action Center for information about pending state and federal legislation and campaigns – including ones to lower out-of-pocket medication costs – and how you can support them. 
  • Be familiar with state and federal resources. All states and the District of Columbia have a state insurance office, which is headed by the state insurance commissioner. If you have a question about your insurance, problems with a claim or access to care, including medications, contact your state office.  For questions or concerns about plans purchased through the Health Insurance Marketplace, visit healthcare.gov. For Medicare, contact your local State Insurance Assistance Program (SHIP), www.shiptacenter.org or visit medicare.gov.  
  • Contact your member of Congress. Let your elected officials know how insurance access and the cost of care affect you. If you want your representatives or senator to support a bill, check Congress.gov to see if they are already a sponsor or co-sponsor of the legislation. If they already support the bill, thank them. If not, ask them to co-sponsor and vote for it. Even if it’s not about specific legislation, contacting your representatives helps you to build a relationship. Share your story so it’s top of mind when bills related to insurance access and medication cost cross their desk or they are asked to co-sponsor a piece of legislation. 

To get started, visit the Action Center and enter your zip code to get a list of your members of Congress. You can even send an email directly from the site.

  • Get involved. Contact your local Arthritis Foundation office or visit arthritis.org to learn how you can become an arthritis advocate. As an advocate, you’ll receive regular updates on legislation and how to get involved. The key to success in changing government policies and funding is through grassroots advocacy. Advocates are the most effective resource for making positive changes on Capitol Hill and the states. 
arthritis foundation prescription for access