Aetna recently notified practices about the launch of its Combined Benefit Management Drug List, which will result in romosozumab-aqqg (Evenity) and infliximab (Remicade) moving to pharmacy-only coverage on July 1.
The ACR sent a letter to Aetna opposing this change, which would preclude rheumatology practices from obtaining these drugs for buy-and-bill administration, instead requiring acquisition through an approved specialty pharmacy. Specialty pharmacy acquisition is not feasible for most rheumatology practices due to the negative impact on practice finances and administrative burden. Policies that require use of specialty pharmacy drugs often necessitate a change in the site of treatment, which results in higher costs and reduced access for patients.
The ACR will be meeting with Aetna later this month to discuss these changes and the impact on rheumatology practices. For questions or additional information, reach out to [email protected].
