Advocates from the North Carolina Rheumatology Association traveled to Washington, D.C., to secure legislative commitments from North Carolina senators and representatives on four critical medical access policies.
The delegation met directly with congressional lawmakers to target insurance practices that delay patient treatments. Specifically, the group lobbied for stricter regulations on prior authorization and step therapy protocols, which force patients to try cheaper medications before approving doctor-prescribed therapies. The association also pushed for federal pharmacy benefit manager reform and addressed the financial strain of underwater biosimilars—which are lower-cost, highly similar alternatives to brand-name biologic medicines derived from living organisms.
A systemic issue occurs when the acquisition cost of these complex medications exceeds what insurance pays back, and advocates said that puts local medical practices "underwater." When community clinics can no longer afford to absorb these losses, they must stop offering the infusions, forcing patients into high-cost hospital outpatient settings.
Because hospitals add heavy facility fees, the rheumatologists said patients face skyrocketing out-of-pocket expenses for the exact same treatment, or are forced into dangerous, insurance-mandated medication switches.
