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 is working to oppose this change.
Aetna Expands Evaluation & Management Downcoding Program
Aetna recently expanded its Claim and Code Review Program, which results in the downcoding of certain level 4 and 5 evaluation and management claims. Practices are advised to monitor remittance documents for appropriate reimbursement.
One Rheumatologist’s Sabbatical for Contemplative Leisure
The year before my hike, I was extremely busy with various ACR workforce issues; meetings; presentations, locally, regionally and nationally; juggling medical missions and more. However, I had blocked time in my calendar over one year in advance to hike the Camino de Santiago in Spain with a long-time U.S. Army buddy. I met Pat…
President’s Corner: The ACR & Pediatric Rheumatology
My first exposure to pediatric rheumatology came during my adult rheumatology fellowship, when pediatric rotations were part of our curriculum. This experience brought home for me the many differences between childhood and adult rheumatic diseases and the important role pediatric rheumatologists play in patient outcomes. This role has long been appreciated by the ACR/ARP, where…
Rheuminations: The Metaphors, Mythologies & Rituals of Medicine
“Doctor, I hate to tell you this but that shelf is definitely not made of wood,” my patient gently chided me as I knocked on a plastic piece of shelving. “I know … but you get the point,” I replied with a small laugh. It’s become a habit of mine over the past few years…
Psychosocial Factors & Pain in Hand Osteoarthritis
Attention to factors beyond the standard nociceptive model of painin patients with hand OA, including psychosocial considerations &other comorbidities, may impact a patient’s pain perception &pain course.
Rheuminations: Can We Now Control the Wolf?
Lupus has always had a reputation for being a wild, unrestrained and enigmatic entity. In fact, the very name lupus comes from the Latin word for wolf, a gift from our Roman predecessors who saw a resemblance between lupus rashes and a wolf’s bite. Given the limitations of immunology back then, it is an incredibly…
New Discoveries in Sjögren’s Disease
Although dryness and other symptoms of Sjögren’s disease continue to vex patients, the prospect of new treatments and a recent name change demonstrate advances in patient care.
FDA Approvals: Lupus Nephritis
Lupus nephritis is one of the leading causes of mortality for patients with systemic lupus erythematosus (SLE), and patients with both SLE and end-stage renal disease have standardized mortality ratios more than 60 times that of patients with SLE with normal kidney function.1 The good news: Rheumatologists now have not one, but two approved options…
Trials Find Potential Treatments for SLE, Lupus Nephritis
In summer 2024, two phase 3 studies were released with promising findings for the treatment of patients with systemic lupus erythematosus (SLE) and those with lupus nephritis. SLE Disease Activity Dapirolizumab pegol is a novel, investigational, Fc-free anti-CD40L agent for people living with moderate to severe SLE.1 The randomized, double-blind, parallel-group PHOENYCS GO trial (N=321)…
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