Don’t reinvent the wheel. The ACR Committee on Rheumatologic Care (CORC) has published support for clinically appropriate use of off-label therapy and now offers members an updated slate of template letters to help appeal insurance denials for common off-label rheumatology treatments.
As past CORC Chair Marcus Snow, MD, FACR, once told The Rheumatologist, “CORC is … made up of practicing rheumatologists who report back to the ACR from the front lines of clinical care. We act as a sounding board for clinical issues. Anything having to do with the practice of rheumatology is the purview of our committee. We focus mainly on the day-to-day practice of the specialty and look for ways around obstacles that get in the way of providing perfect patient care.” In short, CORC promotes the economic, technical and ethical interests of the broad rheumatology community. In 2024, CORC began working on a common issue experienced by rheumatologists and rheumatology professionals: the denial of prescribed therapy by a patient’s insurance provider.
The committee recently published an updated position statement on U.S. Food & Drug Administration (FDA) labeling, affirming ACR support for the use of off-label therapy when deemed clinically appropriate considering sound scientific evidence, patient condition and emerging data. The ACR maintains that FDA labeling should not be regarded as the sole authority in determining standard of practice, and the ACR opposes denial of therapy solely due to lack of FDA approval.
CORC has gone further, compiling an updated slate of template letters that can be used to help appeal insurance denials for off-label treatments frequently seen in rheumatology practice. These template letters may be downloaded and used as a resource by all U.S.-based ACR and ARP members. These include references to peer-reviewed reports, studies and other literature regarding the use of the designated treatment. Letters can be customized to include specific patient, diagnostic or clinical information relevant to the appeal.
Members can access template letters at any time on the ACR website under the Insurance Advocacy tab. The current list of available letters:
Off-Label Drug Use Letters
- Adalimumab—Sarcoidosis
- Apremilast—Biologic Combination Therapy
- Infliximab—Uveitis
- Rituxan—Myositis
- Rituximab—Lupus Nephritis
- Rituximab—Myositis
- Rituximab—Scleroderma
- Rituximab—Severe SLE
- Sildenafil—Refractory Ulcerative Raynaud’s Phenomenon
Pediatric Letters
- Anakinra—Macrophage Activation Syndrome (MAS)
- Biologics—Relapsing Chondritis (RP)
- Infliximab—Sarcoidosis
- IVIG—Myositis
- MRI—Temporomandibular Joint (TMJ) Arthritis
- Rituximab and Cytoxan—CNS Lupus
Members are encouraged to contact the ACR/ARP via email at [email protected] with feedback regarding insurance template letters or to share information about other commercial payer concerns.
