Patient Advocacy
State Policy
United States
Medicare Payer Issues Congressional Outreach
Timeline
6 Weeks
Service Area
Events
Region
United States
Spanning an intensive six-week timeframe, this rapid-response advocacy campaign was executed in partnership with a biotechnology company. The initiative was designed to quickly activate national stakeholder groups to address a critical Medicare payer issue affecting patient access to medication.
Results
6
Week policy reversal
49
Congressional members
23
US States
The Challenge
Specific Medicare Administrative Contractors (MACs) decided to limit access to rheumatoid arthritis (RA) medications by placing them on the Self-Administered Drug Exclusion List. This policy change threatened to cause abrupt disruptions in care for patients who rely on in-office, physician-administered treatments because they are unable to self-inject. The primary challenge was to reverse this restrictive decision and elevate the issue to the Centers for Medicare Services (CMS) to ensure no other MACs attempted similar coverage changes.
Our Approach
We deployed a comprehensive outreach and activation strategy focused on payers, Congressional members, CMS, the media, and patients. Key pillars of the approach included:
Rapid Stakeholder Engagement
Within just two weeks, we identified and reached out to 30 third-party organizations. Outreach specifically targeted groups focused on arthritis, women’s health, seniors, and healthcare disparities. We briefed these organizations and collaborated with them to enhance their social media and communications presence.
Facilitated Dialogue & Action
We developed multiple mechanisms for engagement—including letters, action alerts, and social media campaigns—to support direct dialogue between the organizations, payers, Congressional members, and CMS.
Targeted Media Support
To ensure the patient voice was heard, we helped identify patient advocates, supported the placement of op-eds, and provided media training to patients for potential video and broadcast opportunities.
The Outcome
The rapid activation led to a highly successful outcome, and the initiative was recognized by industry partners as one of the "best and quickest" advocacy campaigns executed to date. Key milestones included:
Policy Reversal
The campaign achieved its desired outcome within the six-week timeframe. Immediate pressure generated by CMS and congressional members forced the Medicare payers to reverse their decision, keeping the critical drug coverage under Medicare Part B.
Extensive Congressional Outreach
The initiative successfully engaged 49 congressional members across 23 states within a concentrated four-week window.
High Visibility
The campaign successfully garnered significant media and social media attention, elevating the issue and creating the necessary pressure to protect patient access.
