The ACR is engaging with payers regarding formulary requirements that would leave practices underwater when treating patients with rheumatic diseases.
The ACR Insurance Subcommittee recently sent a letter to several major commercial payers who require patients to use the biosimilars infliximab-axxq (Avsola) or infliximab-dyyb (Inflectra), despite reimbursement falling below acquisition cost at many independently owned rheumatology practices. The ACR supports use of biosimilars and is encouraged by their overall impact on reducing drug costs; however, requiring practices to infuse any drug at a loss undermines financial solvency and is unacceptable. The ACR letter expressed concern that, unless payers immediately address this situation, practices may be obliged to send patients to another site of care where treatment would be more expensive. Discussions on this issue are ongoing, and ACR leaders are looking forward to meeting with payers to further address these concerns.
For more information or to request ACR assistance with an insurance issue, contact [email protected].