Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
Patients Have No More Skin to Give: Dr. William Harvey Testifies on Rheumatology Issues before Senate Committee
Prior authorization treatment delays, the preferred status conferred on some drugs by pharmacy benefit managers and exorbitant co-payments were among the issues brought before the U.S. Senate Special Committee on Aging on Wednesday, Feb. 7. William F. Harvey, MD, MSc, FACR, a practicing rheumatologist at Tufts Medical Center in Boston and volunteer on the ACR…
Patients with Gout May Be More Likely to Develop Osteoporosis
NEW YORK (Reuters Health)—People with gout face a modestly increased risk, of about 20%, for developing osteoporosis, compared to people without gout, researchers in Taiwan suggest. In their population-based study to examine a possible association between gout and subsequent osteoporosis, Dr. Victor C. Kok of Asia University (Taiwan), Taichung, and colleagues retrospectively analyzed data from…
How to Avoid Insurance Denials for Prescribing a Biologic Without MTX in Concert
The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
ACR’s 2017 Advocacy Successes
In the ever-changing healthcare delivery landscape, the ACR continues to go to work on behalf of its members to ensure public policies encourage delivery of high-quality rheumatology care and treatment. With stepped-up efforts to meet with federal administrative and Congressional representatives, and broadened coalitions of partners to strengthen advocacy for key issues important to the…
Build Better Leaders: The 2018 ACR/ARHP Leadership Conference Focused on Practical Tips for Guiding Committees, Meetings & Conference Calls
Effective volunteer leaders inspire their committees, and together, they accomplish ambitious goals to ensure the future of rheumatology. Expert consultants shared tips and tools for effective leadership at this year’s ACR/ARHP Leadership Conference, held Jan. 22 in Atlanta. “We view your role in the ACR as volunteers to be critical, not only for the success…
Persistent Pain Merits Better Access to Psychosocial Care, Group Says
NEW YORK (Reuters Health)—People with persistent pain need better access to psychosocial care, according to a position statement from the Society of Behavioral Medicine (SBM). “Psychosocial approaches to pain management need to be available for all individuals with persistent pain in all healthcare settings,” Dr. E. Amy Janke from the University of the Sciences, in…
U.S. Healthcare Spending to Climb 5.3 Percent in 2018
WASHINGTON (Reuters)—United States health spending is projected to rise 5.3% in 2018, reflecting rising prices of medical goods and services and higher Medicaid costs, a U.S. government health agency said on Wednesday, an upward trend it forecasts for the next decade. The increase represents a sharp uptick from 2017 spending, which the U.S. Centers for…
Submit MIPS Data to the CMS via RISE by March 2
If you have not done so already, you may submit your 2017 MIPS data to the Centers for Medicare and Medicaid Services (CMS) starting today. Log in to your RISE dashboard, click on all the MIPS categories you would like to report through RISE, and then click on the Submit button. The deadline to submit…
Opioid Makers Paid Millions to Advocacy Groups
(Reuters)—Five opioid manufacturers, including OxyContin maker Purdue Pharma LP, have paid more than $10 million to advocacy groups and doctors tied to them, many of whom amplified industry messages supporting the use of the painkillers, a U.S. Senate report said on Monday.1 The report, released by Sen. Claire McCaskill (D-Mo.), says groups who received the…
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