Experts share tips for building & managing a profitable rheumatology infusion practice, from staffing & billing to inventory & drug costs.
ACR Leads Sign-on Letter to Cigna Opposing Downcoding of E/M Claims
The ACR recently led a rheumatology community letter to Cigna opposing the payer’s decision to downcode level 4 and 5 evaluation and management claims.
AHIP Confirms Continued Coverage of ACIP-Recommended Vaccines Through End of 2026
All vaccines recommended by the CDC’s ACIP as of Sept. 1, 2025—including updated COVID-19 and influenza shots—will be covered by health plans with no cost sharing for patients through the end of 2026.
UHC Formulary Change Impacts Coverage for Ustekinumab
Effective Sept. 1, the brand name drug Stelara will no longer be covered on the UnitedHealthcare commercial plan prescription drug list.
At Summer Meeting, Insurance Legislators Discuss Policies Impacting Rheumatology
The National Council of Insurance Legislators (NCOIL) 2025 Summer Meeting, held July 16–19 in Chicago, Ill., included discussion of several policy issues relevant to rheumatology.
White Bagging: A ‘Prescription for Disruption’ in Rheumatologic Care
In a recent op-ed published by MedCity News, rheumatologist and ACR Insurance Subcommittee Chair Michael Feely, MD, delivers a powerful critique of the insurance practice known as white bagging, calling it a “prescription for disruption” that threatens the quality and timeliness of patient care.
August Updates from the ACR Insurance Subcommittee
The Insurance Subcommittee of the Committee on Rheumatologic Care is working on behalf of ACR members to address critical coverage and reimbursement challenges.
Aetna Implements Specialty Pharmacy Requirements
On July 1, Aetna launched its new Combined Benefit Management Drug List, effectively moving romosozumab-aqqg (Evenity) and infliximab (Remicade) to pharmacy-only coverage for most fully insured commercial plans. The ACR has contacted Aetna leaders to raise concerns about patient access to these therapies.
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.
Underwater Biosimilars Coalition Shares Results of Practice Survey with Congressional Leaders
This week, the Coalition sent Congressional leadership a letter detailing the results of a recent survey about how underwater biosimilars are impacting physicians’ ability to provide high-quality care. Almost all of the nearly 200 practices queried reported being underwater on several biosimilars, with rituximab and infliximab biosimilars being the most common.
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