Want Home Infusion Help? Look to the Hill
‘Any willing provider’ laws, other legislative wins can be had via lobbying and grassroots advocacy
Originally published in Specialty Pharmacy Continuum, Oct. 11, 2019, by Karen Blum
Orlando, Fla.—Leaders at ARJ Infusion Services in Lenexa, Kan., didn’t set out to be involved in government affairs. But three years ago, a patient called to say he received a letter from their Medicaid managed care organization (MCO) stating that within 30 days, all of his specialty prescriptions and infused drugs would have to go through that MCO’s in-house specialty pharmacy.
ARJ CEO Andy Copeland told attendees at the 2019 NHIA (National Home Infusion Association) Annual Conference that he wasn’t quite sure where to start. So he emailed his state senator, who then met with ARJ leaders and the state secretary of health and environment in his office within 48 hours. Fortunately for ARJ, the secretary explained it was a misunderstanding, but Mr. Copeland and his colleagues decided on the drive home that they “weren’t going to be behind the eight ball anymore.” Knowing their law firm had a government affairs group, they reached out to ask how to start getting involved in state legislative advocacy.
ARJ hired lobbyists in the Midwestern states they service who spend time in the capitals every day. These individuals monitor state legislative issues and help get the company’s message across to legislators and their staff. “It’s not an inexpensive undertaking; it’s an insurance policy like anything else,” Mr. Copeland said during a session on strategies for influencing state legislation and rulemaking.
But the lobbyists on the ground hear things about proposed legislation that the company might not otherwise be attuned to, he said: “More than once, we’ve had frantic phone calls asking where we are on a certain issue that was either dead or dormant that has all of a sudden started moving.”
ARJ also wanted to ensure its business was protected by putting forth new legislation. ARJ started a campaign with its lobbyists to introduce “any willing pharmacy” law in Kansas for managed Medicaid— which passed in 2017 as part of a larger Medicaid reform bill—indicating that patients can use their pharmacy of choice as long as the pharmacy is willing to meet the MCO’s “reasonable contract terms and conditions” for network participation.
Companies can find lobbyists through their state legislature websites. Lobbyists are required to register, and their listings should indicate their specific clients, offering you a sense of who might represent your business well or have conflicts of interest barring them from taking you on as a client.
Those who don’t have the resources to hire lobbyists can follow legislation on their own by viewing their state’s legislature websites, the speakers said. Some companies just track bills, and if you provide the states you are interested in, they will give you a price for that service, noted Kyle Gilster, JD, a partner with Husch Blackwell in Washington, D.C.
But be mindful that while things move slowly at the federal level, legislation in the states can move much faster, according to Mr. Gilster. “It’s extremely important to recognize how often your legislature meets, when they meet, and what their process is for bill introduction and hearings,” he said. The Texas legislature, for example, meets only every other year. “If you discover you’ve got a problem once they adjourn in October, you’ve got to wait 14 months before you can do anything. Timing is everything; you’ve got to be watchful.”
Each state has some form of health and human services administrative function that can greatly affect home infusion and healthcare businesses, and they are open to constituents’ issues all year. “Clearly, the state legislature writes the laws, but never underestimate the executive branch, because they’re the ones who implement and interpret the laws,” Mr. Gilster said.
Healthcare businesses should consider implementing both grassroots and grass-tops advocacy campaigns, he added. Grassroots would involve activities like telling patients’ stories or having them write letters or testify at a hearing about how proposed legislation affects their lives and ability to get care. Grass-tops activities include using social media to promote your agenda or placing an op-ed piece in your local paper. “The most effective government affairs strategy, in my opinion, is grassroots, grass-tops, and face-to-face interaction—meeting folks in person,” he said. “Legislators will listen to you more if they’re getting letters, calls, and emails from people in their districts.”
At the state level, many legislators are only in office for a short time, and they are not necessarily healthcare experts, Mr. Copeland said. In Kansas, for example, legislators tend to have one staff person for each office, and that’s mainly someone to answer the phone, not necessarily a legislative expert. “It’s really remarkable to see how much they rely on lobbyists,” he said. “You get to help shape their opinion on issues.”
Mr. Gilster’s law firm works on issues related to healthcare reimbursement. The other sources reported no relevant financial relationships other than their stated employment.