ACR Report Underscores Need for Improved Rheumatic Disease Care


New report assesses the quality of rheumatic disease care across all 50 states and calls for improvements that address access to affordable care.

In the United States, the prevalence and cost of rheumatic diseases, which affect 1 in 4 Americans, pose a public health concern due to the growing number of patients who have difficulty accessing affordable care.

Kicking off September as Rheumatic Disease Awareness Month, the American College of Rheumatology (ACR) released a report assessing the quality of rheumatic disease care across all 50 states. The report, called the Rheumatic Disease Report Card, assigned letter grades to each state and the District of Columbia based on their progress in addressing access, affordability, and lifestyle factors associated with living with a rheumatic disease.

Maryland earned the highest marks, while Oklahoma and Alabama received the lowest grades in the report. Overall, the average grade given was a “C,” with most states receiving either “C” or “B” marks. The findings indicate that widespread improvements are needed to address patients’ barriers to care.

The ACR named a few challenges to accessing rheumatology care: a severe rheumatologist workforce shortage, lack of insurance coverage, and delays caused by restrictive insurer practices.

“Even in states where patients can find a rheumatologist, their prescribed treatment costs are often exorbitantly expensive, as few states have taken measures to curb secretive pricing practices employed by pharmacy benefit managers (PBMs) or put limits on insurers’ use of specialty tiers that implement cost-sharing models,” the ACR stated in a press release.

Maryland, which was the only state to receive an “A” grade, has a high concentration of rheumatologists, low uninsured rates, laws to ensure affordable rheumatology care, and several CDC-funded arthritis intervention programs. In Arkansas, legislative efforts to address PBM transparency resulted in the state receiving a high grade in affordability, which could serve as a model for other states looking to address this issue.

Despite Arizona’s low rheumatologist concentration, the state received distinction for its efforts to educate primary care physicians in remote areas about rheumatic diseases to help improve care.

Without early intervention and appropriate treatment, rheumatic diseases can cause painful symptoms and result in long-term disability, organ damage, and premature death. Unfortunately, the cost of therapies for these conditions can lead to a high financial burden and barriers to access. The Vizient Drug Price Forecast projected disease-modifying anti-rheumatic drug (DMARD) prices to skyrocket 11.85% in 2018, making this drug class the largest driver of drug cost increases.

“Rheumatic disease can be debilitating—but they don’t have to be if a diagnosis is made without delay and appropriate treatment is started,” David Daikh, MD, PhD, president of the ACR said in the press release. “We hope this report will help people understand that they have the power to turn the tide on this public health crisis by taking steps to raise their state’s grade on rheumatic disease care.”

The ACR recently released statements on new CMS policies regarding indication-based formulary design for Medicare Part D plans and step therapy, indicating that both policy decisions could harm patient access to treatment.

The full Rheumatic Disease Report Card can be found here.


American College of Rheumatology Releases First-Ever Rheumatic Disease Report Card [news release]. American College of Rheumatology. Accessed September 4, 2018.

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