Community practice rheumatology may be a less-followed path within the specialty, and it brings with it certain challenges. However, it also offers rewards, such as autonomy and deep relationships with patients. The Rheumatologist recently interviewed three community practice rheumatologists from around the U.S. to find out about their approaches to patient management, staffing and other…
Slow but Steady: 2023 State Legislative Progress
This legislative season has seen key pharmacy benefit manager reforms but slow movement on other issues, such as copay accumulators and utilization management. The ACR is also monitoring emerging topics, such as biomarker testing and post-public health emergency telehealth reforms.
ACR Insurance Subcommittee Tackles Known Issues
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.
Big Utilization Management Reform Wins in Pennsylvania, Massachusetts
Prior authorization and step therapy reform bills recently enacted in Pennsylvania and Massachusetts offer case studies into how substantive policy change can take persistence, patience and a bipartisan approach to achieve success.
Advocacy Highlights & Fall Treats: Reflections from the GAC Chair
Outgoing Government Affairs Committee Chair Blair Solow, MD, offers advocacy updates from 2022 and seasonal reflections on how to stay focused on efforts that matter when faced with daunting challenges.
ACR Praises House for Passing Prior Authorization Reform Bill
WASHINGTON, D.C.—On Sept. 14, the ACR praised the House of Representatives for overwhelmingly passing bipartisan legislation intended to make it easier for Medicare Advantage beneficiaries to access the timely care they need. The Improving Seniors’ Timely Access to Care Act (H.R. 3173) passed the House on a voice vote. If enacted, the bill will create…
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
Prior Authorization Reform: Bill Calls for Faster Care, Fewer Denials
With 290 cosponsors, ACR-supported legislation to streamline prior authorization in Medicare Advantage plans has met a support threshold that may allow the lead sponsor to force House action.
CVS Issues Revised Prior Authorization Forms
In response to ACR and provider concerns about administrative burden, CVS Caremark has issued a streamlined version of its prior authorization forms for many biologic drugs.
ACR Leaders to Meet with Members of Congress at May 12 Capitol Hill Event
The meetings will focus on legislation affecting rheumatology, including bills on graduate medical education and use of copay assistance funds.
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