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.
ACR Meets with Trump Administration to Discuss 2026 Physician Fee Schedule Proposed Rule
Issues discussed at a meeting with the Office of Management & Budget included increasing Medicare reimbursement for physicians, telemedicine permanence, removing G2211 restrictions, adequate reimbursement for therapies and more flexibility for chemotherapy administration codes. The proposed rule is currently under review by the OMB, which is usually the last step prior to releasing publicly for stakeholder review and comment.
CMS Announces Changes to Clinical Laboratory Improvement Amendments Fee Coupons & Certificates
Clinical researchers who perform laboratory testing are required to switch to email notifications before March 1, 2026, to continue receiving fee coupons and certificates. After that date, CLIA paper fee coupons and certificates will no longer be available.
The ACR Calls on CMS, OMB to Reduce Burdensome Healthcare Regulations
In response to agency requests for feedback on how to streamline regulations and reduce administrative burden on Medicare program stakeholders and small business owners, the ACR called for the removal of certain regulations related to prior authorization, pharmacy benefit managers and Medicare Part B and Part D access.
Inaugural Practice Innovation Summit Focuses on Building a Blueprint for Private Practice Success
Registration is now open for the first-ever Practice Innovation Summit, which will dive into operational and financial strategies to grow and sustain private and community-based practices.
ACR Responds to Aetna Specialty Pharmacy Requirements
Aetna recently notified practices about the launch of its Combined Benefit Management Drug List, which will result in romosozumab-aqqg (Evenity) and infliximab (Remicade) moving to pharmacy-only coverage on July 1. The ACR is working to oppose this change.
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.
Advocates for Arthritis 2025: United for the Future of Rheumatology Care
In visits to Congress members and staff, more than 120 ACR/ARP members and patients urged action to improve patient access to quality treatment. The meetings included discussions about the importance of research funding, ensuring adequate Medicare reimbursement, protecting Medicaid, and making PBMs more transparent and accountable. It’s not too late to amplify their message.
Incorporating Patient-Reported Outcomes into the Clinic
‘Measuring patient-reported outcomes (PROs) is an important component of high-quality, patient-centered care, but integration of PROs into clinic can be challenging,’ says Physician Editor Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS. ‘Luckily, tools exist to help us realize this vital aspect of patient care.’ The ACR’s quality measures for care include gauging disease activity and…
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