Patient Advocacy: The Bigger Picture and How to Get Involved
May 1, 2025
Patient Advocacy: The Bigger Picture and How to Get Involved
By Alisa Redmon
As a Biologic Coordinator (BC), you’re not just managing prior authorizations—you’re an advocate.
Advocacy is defined as publicly supporting a cause or policy. In our world, that cause is ensuring patients have timely and consistent access to the medications they need to live healthier lives. Our determination and passion are often what push access over the finish line. But while we make an impact every day on an individual level, it's time to ask: What about the bigger picture?
Let’s explore why our daily challenges exist, what’s behind them, and how we can use our voice to drive lasting change.
Why Is the System So Broken?
At the heart of many access issues are Pharmacy Benefit Managers (PBMs)—the middlemen hired by insurers to manage prescription drug benefits. They have outsized power in determining:
Drug criteria: What the patient must “fail” before the requested med is covered
Formularies: Which drugs are preferred (and subject to change at any time)
Rebate negotiations: $$$-driven deals that influence drug coverage
Mandated specialty pharmacies: Even when service is poor or inconvenient for the patient
One of the biggest roadblocks we face is step therapy—when a patient is forced to try and fail insurer-preferred treatments before accessing what their provider originally prescribed. This process isn’t about what’s clinically best—it’s about saving money. And that can come at the cost of delays in care, disease progression, and serious adverse outcomes.
Who’s Reviewing These PA Requests?
Here’s the question many of us are asking: Who or what is actually reviewing our prior authorizations?
With the rise of AI integration, reviews are becoming less personal, less thorough, and more automated. And while automation may bring speed, it often fails to grasp nuance or context—creating unnecessary denials, appeals, and wasted time for all parties involved. The reviewing process desperately needs reform and human oversight.
The Impact of Formulary Changes and Biosimilars
We’ve seen a wave of formulary changes in the past year, often forcing stable patients to switch medications—even if they’ve been well controlled for years. As biosimilars continue to flood the market, this trend is only going to increase.
Some manufacturers offer support through patient assistance programs, but these are temporary solutions to a systemic problem. And while we can sometimes secure formulary exceptions, it’s not nearly enough to keep up with the growing burden.
This is why PBM reform isn’t just important—it’s urgent.
Spotlight: The Safe Step Act (S.652)
Introduced in the U.S. Senate in 2023, the Safe Step Act aims to provide common-sense protections for patients facing step therapy. It requires exceptions when:
The patient has already tried and failed a preferred medication
The preferred medication is expected to be ineffective or cause harm
Delaying treatment could lead to irreversible health consequences
The preferred medication would limit daily functioning or job performance
The patient is stable on their current therapy
Unfortunately, most insurers only acknowledge the first exception, leaving patients and coordinators to fight uphill battles using the other (equally valid) criteria. Still, these exceptions are important tools in appeal letters and peer-to-peer reviews.
The Safe Step Act currently exists only at the state level. The goal is to move it to federal legislation, but as of September 2024, the following states do not have these protections in place:
Idaho
Montana
Utah
North Dakota
Michigan
Alabama
South Carolina
Washington D.C.
New Jersey
New Hampshire
Rhode Island
So, How Can You Get Involved?
The fight for patient access isn’t just happening in the clinic—it’s happening in legislation, advocacy campaigns, and online petitions. As a BC, your voice matters.
Here are some ways to plug in:
Final Thoughts
Being a BC means showing up for your patients every single day, even when the system makes it hard. But if we want real change, we must also show up outside of the office—in advocacy, in policy discussions, and in reform efforts.
You already have the experience. You already have the passion. Now, let’s use our collective voice to reshape the system—for the sake of our patients and the future of access.
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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.