In front of the U.S. House Ways and Means Subcommittee, Dr. Edgerton described how challenges of biosimilar costs threaten patient care and outlined several potential legislative solutions.
March Updates from the ACR Insurance Subcommittee
The Insurance Subcommittee is working on behalf of ACR members to address underwater formulary requirements for biosimilars, mandated switches to biosimilars, evaluation and management downcoding and more.
Will Telehealth Make It to April?
Medicare’s current telehealth flexibilities are set to expire March 31. To avoid a government shutdown, Congress must pass a appropriations package by midnight on March 14. The ACR is preparing for the impacts if a telehealth extension does not pass.
Rheumatologist Elected to Key AMA Committee That Helps CMS Set Medicare Reimbursements
Luke Barré, MD, MPH, RhMSUS, has been elected to the American Medical Association’s Relative Value Update Committee. He is the second rheumatologist to hold the seat in recent years and will ensure representation of the specialty during valuation of physician services.
ACR Comments on Proposed Medicare Advantage Changes
In response to proposed changes to the Medicare Advantage and prescription drug programs for contract year 2026, the ACR submitted comments on the provisions related to the Inflation Reduction Act, prior authorization and the influence that pharmacy benefit managers have on the placement of biosimilars on formularies.
Hit the Ground Running with New Insurance Subcommittee Chair Michael Feely, MD
Dr. Feely discusses his previous work with the College, his current work as a practicing rheumatologist and how he will lead continued advances on the insurance front.
What Providers & Patients Should Know About Medicare Benefit Changes in 2025
Changes to Medicare benefits in 2025 include an annual $2,000 cap on out-of-pocket costs for covered Part D drugs and a new, voluntary Medicare Prescription Payment Plan intended to help beneficiaries manage drug costs.
Resources for Practices to Fight Payer Downcoding of E/M Services
The American Medical Association and ACR Insurance Subcommittee offer support and guidance to help practices recognize and push back against downcoded payments for evaluation and management services.
How the ACR Helps with Reimbursement, Utilization Management & Other Practice Challenges
Improving reimbursement for underwater biosimilars is just one example of how the ACR’s practice advocates have achieved solutions to members’ insurance challenges. Here’s a look at current ACR efforts in insurance advocacy and how to get help with your own insurance challenges.
ACR Leads Coalition Effort Opposing UHC Policy Change on G2211
In July, UHC announced it would discontinue reimbursement for G2211 for commercial plans as of Sept. 1. The ACR led a multispecialty sign-on letter urging the payer to reconsider its decision to help ensure clinicians can maintain the additional work needed to manage complex and chronic diseases.
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