Success at the states

By Ruth Carol, Contributing Writer, March 1, 2025

From preventing scope of practice creep to overturning modifier 25 policies, the Academy partners with state dermatology societies to ensure dermatologists’ ability to provide the best care possible for their patients.

“The state dermatology societies are the boots on the ground,” stated Aliya Courtney Hines, MD, PhD, FAAD, chair of the Academy’s State Policy Committee. “They are the first responders who let us know what’s happening and how we can help.”

Parallel priorities

All states, excluding Alaska and North Dakota, have a formal state dermatology society that collectively advocates for dermatologists at the local level. State societies are independent from the Academy, but they work alongside each other to address issues that align. “States have their own priorities, but many times they are parallel with the Academy’s priorities,” Dr. Hines noted.

State dermatology societies provide invaluable insights into local politics while the AADA provides a broader perspective plus numerous resources and support.

“We rely on states to tell us what they are hearing and what they need from us,” said Lisa Albany, JD, director of state policy at the Academy. “What worked well in one state might not play out well in another. We don’t want to go in and do something that is not helpful,” she added. On the flip side, the Academy has experience in dealing with the same issues occurring in states across the country. “If something positive can be replicated, we can share it to use in other states, or if something negative happens in one state, we can share it as a cautionary tale,” Albany stated. This collective information helps the Academy learn about emerging issues that will impact dermatologists and identify national trends, all of which help shape its advocacy efforts, Dr. Hines said.

The Academy tailors its support, depending on the state dermatology society’s needs, Dr. Hines explained. Sharing approaches to legislative issues, providing language for model legislation, making connections with private payers, assisting in developing relationships with legislators, and offering advocacy grant awards are just a few ways the AADA supports state societies.

Grassroots advocacy

“It’s important to engage in state dermatology societies in large part because we’re a specialty with unique needs,” Dr. Hines said. “We need everyone’s help to advocate for the specialty.” Getting involved can be as simple as responding to an action alert sent by either the AADA or a state society. The Academy recently implemented a new grassroots advocacy program that will make it easier for members to quickly communicate their position on proposed legislation at the state level, Albany said.

“It’s important to engage in state dermatology societies in large part because we’re a specialty with unique needs.”

The AADA encourages members to reach out to a state legislator and offer to serve as a resource on health care issues. “Those types of person-to-person outreach efforts are quite successful at the state level,” Dr. Hines said. Another option is to invite a legislator to visit their practice to gain a better understanding of what it’s like to practice in today’s health care environment, or consider testifying at a committee meeting at the state capital. The more dermatologists get involved in advocacy efforts, the stronger the state dermatology societies become.

In 2024, the Academy and state dermatology societies had numerous advocacy wins. The following examples highlight their success.

Scope of practice

Scope of practice remains an ongoing issue for many dermatologists concerned about the quality and safety of dermatologic care offered by non-physician health care professionals. The Academy, in partnership with the American Medical Association (AMA) Scope of Practice Partnership and state dermatology societies, was able to put the brakes on scope of practice expansion bills in 2024.

In South Dakota, the AADA worked closely with the house of medicine and South Dakota State Medical Association to defeat a bill that would have allowed physician assistants (PAs) to practice independently. This is the fourth consecutive year that PAs have pushed for independent practice in this state, Albany noted.

In Wisconsin, Gov. Tony Evers (D) vetoed a bill that would have allowed nurse practitioners (NPs) and other mid-level providers to gain independent practice. This is the second legislative session in a row that the governor vetoed such a bill, she said. The Wisconsin Dermatological Society received a Development Advocacy Grant that it used to host a lobby day around scope of practice, work with stakeholders, and meet with legislators, Albany said.

In New Hampshire, optometrists were prevented from expanding their scope of practice to perform minor eye surgeries, including laser procedures. The Academy was made aware of the legislation by local ophthalmologists, a frequent ally in scope of practice issues related to optometry, Albany said. The AADA also worked with the house of medicine, sending letters opposing the legislation and action alerts. A dermatologist testified at the committee hearing about the potential threat to patient safety.

In Arizona, a bill was defeated that would have allowed dental hygienists the ability to inject fillers and botulinum toxin. Initially, the Arizona Medical Association came out neutral on this issue, making it more difficult to gain support from legislators, Albany said. Having dermatologists explain that these are medical procedures that should be performed by a physician, or appropriately trained non-physician personnel under direct supervision of a trained physician, was instrumental in convincing the state association to change its position, she said.

In Washington, D.C., components of a broad scope of practice bill passed; optometrists were prevented from expanding their scope of practice. The Academy worked closely with the Medical Society of the District of Columbia and Washington, D.C. Dermatological Society. The medical society led a broad campaign educating local specialists about the importance of having a physician lead the health care team, Albany noted.

Some of this legislation has been introduced multiple times, she said, adding, “It becomes very frustrating for dermatologists to see these wins and then have to repeat the process the following year.”

Truth in advertising

Health care professionals have a wide spectrum of training and expertise but their credentials can confuse patients. The Academy maintains that all health care practitioners should identify or disclose their degree or field of study, board certification (if any), and licensure to patients prior to treatment. “The bottom line is: we just want patients to be aware of who they’re seeing,” Dr. Hines said.

In Tennessee, Gov. Bill Lee (R) signed legislation limiting the use of medical specialty titles in advertisements. It requires any advertisement for health care services to include the practitioner’s name and the type of licensure or profession held. This is an “ologist” bill, the first of which was passed in Indiana in 2022, that allows only individuals with an MD or DO degree to refer to themselves as, for example, dermatologists, anesthesiologists, or cardiologists, Albany explained. The AADA supported the Tennessee Dermatology Society through a State Advocacy Grant and written comments, she noted.

The Delaware Academy of Dermatology was instrumental in preventing legislation about truth in advertising from moving forward that did not adequately protect patients, Albany said. The bill was introduced by the House Majority Leader who ended up pulling it. A dermatologist had reached out to legislators on the committee to discuss why the legislation was insufficient and encouraged local colleagues to do the same, Albany said. When battling truth in advertising legislation, it’s essential that dermatologists explain why it’s so confusing to patients when health care professionals don’t divulge their qualifications and to provide patient examples, Albany added.

Prior authorization

In 2024, states looked to create a legislative fix to reduce the burden on physicians and patients created by prior authorization requirements implemented by payers.

In New Jersey, Gov. Phil Murphy (D) signed legislation, effective Jan. 1, 2025, that requires insurers to validate approvals for 180 days and respond to prior authorization requests in an expedient manner. The AADA supported the efforts of the Dermatologic Society of New Jersey through written testimony and a State Advocacy Grant.

A prior authorization bill that passed in Maryland removes the need for re-authorization for a prescription drug used to treat chronic conditions for up to one year and requires the payer to approve a step therapy exception request when a prescriber determines that a step therapy drug is detrimental to a patient. It also dictates how prior authorization criteria are established and a preauthorization request process that includes electronic submissions and established timeframes. The law, which took effect in October 2024, calls for a report exploring the use of gold cards, which waive prior authorization requirements for certain services and drugs for physicians with a proven track record of prior authorization approvals.

The Academy was working on this legislation prior to 2024, and the 2024 language reflected feedback from the members of the Maryland Dermatologic Society who testified in 2023 and participated in a workgroup with other stakeholders, Albany said. The AADA gave the Maryland Dermatologic Society a State Advocacy Grant to advance this issue. The state society also held an advocacy day to educate its members about the legislation. Dermatologists sent letters in support of the bill and were joined by other specialists to testify at the hearing, Dr. Hines said. “We’re really excited that this bill passed, and we will be monitoring its effectiveness,” Albany added.

In Colorado, a bill passed that requires payers to eliminate or substantially modify prior authorization requirements, removing administrative burdens on qualified clinicians and their patients. The law, which will take effect Jan.1, 2027, prohibits payers from imposing prior authorization requirements more than once every three years for a chronic maintenance drug that was previously approved and extends the duration of an approved prior authorization for a service or prescription drug benefit from 180 days to a calendar year. The Academy assisted the Colorado Dermatological Society by creating flyers to place in dermatologists’ offices encouraging patients to contact their legislators. The flyers are an effective way to engage patients in legislative issues and the AADA plans to use flyers in other states, Albany said.

Care/treatment coverage and payment

Like it does with legislative efforts, the Academy relies on state dermatology societies to learn about issues related to local coverage, billing, or payment changes made by private payers.

The Academy makes it easy to report such issues through its private payer email privatepayer@aad.org, noted Louis A. Terranova, associate director of practice and payment policy. The AADA posted on its website the Massachusetts Academy of Dermatology’s model legislation to prohibit modifier 25 payment reductions, which could serve as a template for other state dermatology societies, he said. The Academy also created appeal letter templates and prior authorization templates that are posted on its practice management website.

Whether the Academy is informed of such changes by a state dermatology society or through members or other means, it reaches out to the state society to coordinate a strategic approach. “We recognize that state dermatology societies may have their own advocacy agenda and priorities, and established contacts at the local level,” Terranova said. For its part, the AADA can assist by helping draft an advocacy letter, developing talking points, arranging a call with the carrier, or sharing resources from the Payer Access and Patient Relations Committee. Working with the state societies helps the Academy identify trends in policies, he added.

The AADA also monitors these issues. For the past three years, the Academy has had quarterly update calls with national carriers, including Aetna, Cigna, Elevance Health (formerly Anthem), and United Healthcare. “These calls give us an opportunity to find out what they’re doing and to discuss issues that we’re hearing from our members,” he said. They also establish the AADA as a resource. For example, all the national carriers have approached the Academy, at some point, when considering changes to dermatologic drugs on their formularies. This open dialogue has led to positive results, he noted.

“Scope of practice is an ongoing challenge, and we will continue to work on that in several states. ”

The following examples highlight advocacy wins related to local coverage, billing, or payment changes in 2024.

In Florida, Gov. Ronald DeSantis (R) signed legislation requiring state group health plans to provide coverage and payment for annual skin cancer screenings. The screening must be performed by a dermatologist or an advanced practice registered nurse or physician assistant working under the supervision of a dermatologist. The AADA supported the efforts of the Florida Academy of Dermatology through a State Advocacy Grant as well as written testimony. Florida is only the second state to require such coverage; Illinois was the first state that required this coverage in 2020.

Despite precedent for treating vitiligo as a medical condition, Colorado considered vitiligo treatment as cosmetic, Dr. Hines said. But after receiving a letter from the Academy, the Colorado Medicaid program reversed its decision and announced it will cover topical ruxolitinib for nonsegmental vitiligo.

In North Carolina, the state dermatology society contacted the Academy about a BlueCross BlueShield policy change for modifier 25. The North Carolina Dermatology Association members reported that they did not receive any notification other than seeing a post on the carrier’s website, Terranova said. “The policy would have reduced payment for non-preventive E/M services by 50% when billed with a procedure code with a 0- or 10-day global surgery period,” he noted. The AADA coordinated advocacy responses with the state society, AMA, and North Carolina Medical Society, which resulted in the carrier rescinding the policy.

A few weeks later, BlueCross BlueShield of California attempted to issue a similar policy change, Terranova said. The Academy worked with the California Society of Dermatology and Dermatologic Surgery and the California Medical Association on advocacy efforts, including writing a joint letter opposing the policy and meeting with the carrier. “Based on the information and talking points the AADA provided, the carrier overturned its policy,” he said.

In 2024, the Academy heard from a member in Iowa about an issue with Wellmark BlueCross BlueShield in Iowa and South Dakota, Terranova said. The carrier deemed the use of immunohistochemistry (IHC) stains not medically necessary, placing restrictions on their use and requiring prior authorization. The AADA coordinated a response with the state dermatology societies in both states that included developing a letter opposing the change. Wellmark rescinded its policy and restored coverage of payment for IHC stains.

In 2025, more local carriers may try to reduce payment through modifier 25 policies, Terranova said. “With the expansion of biosimilars, we anticipate payers will look at enhancing utilization management programs, such as step therapy or prior authorization,” he added.

Similarly, the Academy expects many of the same legislative issues to resurface in 2025. “Scope of practice is an ongoing challenge, and we will continue to work on that in several states,” Dr. Hines said. The PAs will continue to target states in which NPs have independent practice, Albany said. She anticipates scope of practice legislation being introduced in Indiana, Missouri, New Hampshire, Pennsylvania, South Dakota, Texas, and Wisconsin. Ten states introduced prior authorization legislation in 2024, Dr. Hines said, adding, “What didn’t get done in 2024 will come back in 2025.”

Additional DermWorld Resources