Reimbursement has fallen below acquisition price for some biosimilar versions of infliximab, forcing practices and patients to make difficult decisions. The ACR is working to change this.
Blue Cross NC Revises Autoimmune Pathways Program
After meeting with the ACR and other stakeholders, Blue Cross NC and OMI announced revisions to their Autoimmune Pathways Program to drop biologic tapering requirements and paying providers according to specific treatment decisions.
ACR Insurance Subcommittee Tackles Known Issues
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.
A Unique Partnership Gives the ACR a Voice in Insurance Legislation Development
A recent meeting of the National Council of Insurance Legislators (NCOIL) featured discussions of many topics important to ACR members, including pharmacy benefit manager legislation, biomarker testing and transparency in the healthcare market.
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
Advocacy Leadership Conference: Reflections from an Accidental Rheumatology Advocate
At my first Advocacy Leadership Conference as a member of the ACR’s Insurance Subcommittee, I discovered the power of stories from the clinic and how lawmakers value clinicians’ input on healthcare legislation.
Update from the ACR Insurance Subcommittee
The ISC has worked with CVS Caremark to revisit changes to its prior authorization forms that would have increased the administrative burden on practices, and patients with Blue Cross Blue Shield of South Carolina may not have to worry about switching to a self-administered biologic.
ACR Insurance Subcommittee Chair Encourages Member Engagement
Rheumatology practices have a voice in payer advocacy through the Insurance Subcommittee of the ACR’s Committee on Rheumatologic Care.
ACR Leads AMA Resolution on Payer Financial Incentives to Patients to Switch Treatment
Spurred by a recent Cigna policy, the ACR will lead a resolution to oppose insurance companies providing financial incentives for patients to switch treatments. Several specialties are cosponsoring the resolution for a special meeting of the AMA House of Delegates in June.
Why Community Rheumatologists Serve: Committee Work Pays Off ‘Many Times Over’
Volunteer leaders who are community rheumatologists share their thoughts about the professional and personal benefits of serving on ACR committees and encourage others to get involved.
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