North Carolina Doctors Lobbied for Drug Policy Reform
A state rheumatology delegation met with federal lawmakers to discuss medical access and insurance reimbursement hurdles.
Updated on Oct. 8, 2026 in Arthritis
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The North Carolina Rheumatology Association recently met with congressional representatives in Washington, D.C. to advocate for changes to medical access policies. The delegation sought reforms to pharmacy benefit manager practices and regulations regarding prior authorization and step therapy.
Why it matters
The group highlighted that medical clinics often cannot afford to provide infusions because acquisition costs for complex medications frequently exceed insurance reimbursement rates. This financial strain forces patients into hospital settings, where they often encounter additional facility fees.
The delegation lobbied for reforms across four distinct policy areas including prior authorization and step therapy protocols. These discussions address ongoing financial challenges where clinical acquisition costs for medications outpace insurance reimbursements.
The players
North Carolina Rheumatology Association
This is a professional medical organization representing rheumatologists who manage complex autoimmune and musculoskeletal conditions in the state.
The details
Advocates from the North Carolina Rheumatology Association pressed for federal pharmacy benefit manager reform to address the issue of underwater biosimilars. When clinics stop offering infusions due to financial losses, patients are forced to seek care in hospital outpatient settings that charge facility fees.
Timeline
October 8, 2026: The delegation met with North Carolina lawmakers in Washington, D.C.
The Big Picture
The push for federal oversight follows the regulatory patterns seen in the Pharmacy Benefit Manager Reform Act. These efforts aim to stabilize clinical reimbursement models that currently struggle under existing insurance and pharmacy benefit manager constraints.
Patients may see changes in where they receive infusion therapies if clinics continue to face unsustainable reimbursement rates for biosimilars. These policy shifts directly influence both the affordability of treatments and the location where patients must travel to receive medical care.
The takeaway
The advocacy efforts underscore the growing tension between medical reimbursement models and patient access to necessary specialty infusions. Managing care in a clinical setting remains a priority for doctors seeking to minimize extra hospital-based facility fees for their patients.
Further reading
For more background on the challenges facing specialists, visit North Carolina Arthritis.
Source note: This article includes information reported by Public Radio East.
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