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Legislation & Advocacy

Prior Authorization Reform Achieves Some Success

Ryan Larosa, ACR staff  |  August 17, 2016

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

Reuters Staff  |  August 16, 2016

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

From the College  |  August 10, 2016

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

Kathryn Doyle  |  August 8, 2016

(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

Kathy Holliman  |  August 4, 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

Mary Beth Nierengarten  |  August 4, 2016

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

Caroline Humer & Carl O'Donnell  |  July 22, 2016

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…

ACR Advocacy at the State Level in 2016

From the College  |  July 18, 2016

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…

Medicare Advantage Grows, but Provider Choice Is Limited

Mark Miller  |  July 7, 2016

CHICAGO (Reuters)—Medicare enrollees are moving in greater numbers than ever to the program’s managed care option as a way to save money. But the tradeoff is much less ability to use their preferred doctors and hospitals. Seniors can choose between traditional fee-for-service Medicare—which is accepted by most healthcare providers—or a Medicare Advantage plan. The latter…

White House Proposes Measures to Speed Genomic Test Development

Toni Clarke  |  July 7, 2016

WASHINGTON (Reuters)—The White House announced on Wednesday measures aimed at advancing President Barack Obama’s precision medicine initiative, including plans to speed the development of tests used to identify genetic mutations and guide medical treatment. The U.S. Food and Drug Administration said it planned to issue a proposal to create performance standards to guide development of…

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