Providers are urged to prepare quickly to meet the new Medicare reimbursement requirements mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “The first measurement year starts Jan. 1, 2017, so providers need to prepare quickly,” emphasizes William F. Harvey, MD, MSc, Government Affairs Committee chair, American College of Rheumatology (ACR). 2…
Rheumatology Advocates to Visit Capitol Hill
On Sept. 12–13, a group of more than 100 rheumatologists, rheumatology health professionals and patients will converge on Capitol Hill to take part in advocacy efforts and provide education on issues affecting the rheumatology community. During the 2016 Advocates for Arthritis event, the group will visit more than 100 Congressional offices, says ACR Government Affairs…
More U.S. Counties May See Obamacare Marketplace Monopoly
NEW YORK (Reuters)—Nearly a third of U.S. counties will likely be served by only one insurer that participates in an Affordable Care Act (ACA) marketplace in 2017, according to an analysis published Aug. 28 by the Kaiser Family Foundation. The 31% of U.S. counties that will have just a single option of insurers within the…
Prior Authorization Reform Achieves Some Success
In early August, the American Medical Association (AMA) held its annual state advocacy strategy meeting in Chicago. This meeting pulls together all state medical societies and national specialty organizations. Over three days, participants engage in roundtable discussions on issues, solutions and best practices for health policy. Networking opportunities abound. The meetings showcase legislation that has…
Aetna Pulls Back on Obamacare Health Insurance Plans in 2017
NEW YORK (Reuters)—Aetna Inc., the No. 3 U.S. health insurer, on Monday said that due to persistent financial losses on Obamacare plans, it will sell individual insurance on the government-run online marketplaces in only four states next year, down from the current 15 states. Aetna’s decision follows similar moves from UnitedHealth Group Inc. and Humana…
The ACR’s Advocacy at State Legislature Level in 2016 Focuses on Biosimilars, Step Therapy
A majority of state legislatures have concluded their work for 2016. The ACR’s state advocacy efforts continued to focus on policy benefiting rheumatologists and patients alike. The two dominant issues this year were biosimilar substitution and step therapy. Biosimilar Substitution Biosimilar substitution remains the most prevalent issue throughout the states. The ACR continues to monitor…
Health Has Improved in States That Expanded Low-Income Insurance Options
(Reuters Health)—In states that expanded either their Medicaid programs or private insurance options for low-income Americans, beneficiaries used more outpatient and preventive care and less emergency care. They also had better subjective overall health, compared with low-income residents of states with no expanded coverage. All states participate in Medicaid, a partnership with the federal government…
The ACR Continues Fight to Block Medicare Part B Demo Project: Rule Expected in Fall 2016
The ACR will seek Congressional action if the Medicare Part B demonstration project proposed by the Centers for Medicare & Medicaid Services (CMS) is not significantly altered by the agency. Today, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6% add-on, minus reductions required…
The ACR and Partners Help Get Legislation Passed in New York to Limit Step Therapy
In June, state lawmakers in New York passed legislation on step therapy designed to help ensure patient access to the best and most appropriate care. Step therapy mandates that a patient with a specific condition receive prescribed drugs approved for that condition in the order that an insurance company determines it will cover as the…
U.S. Regulators Sue to Block Anthem-Cigna & Aetna-Humana Mergers
NEW YORK (Reuters)—U.S. antitrust officials on Thursday moved to block an unprecedented consolidation of the national health insurance market, filing suit against Anthem Inc.’s proposed purchase of Cigna Corp. and Aetna Inc.’s planned acquisition of Humana Inc. The U.S. Department of Justice (DOJ) says the two mergers would reduce competition, raise prices for consumers and…
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