An ACR-led resolution that calls for the protection of NIH funding and the ability to negotiate indirect costs will become AMA policy, along with several other resolutions supported by the ACR.
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.
Signed into law in April, the legislation will ban direct and indirect PBM ownership of pharmacies, effective Jan. 1, 2026. It addresses longstanding concerns about conflicts of interest, market consolidation and patient access created by vertically integrated PBM pharmacy models.
As in past administrations, members of the Executive Committee scheduled meetings with leaders of the Food & Drug Administration and Centers for Medicare & Medicaid Services to discuss ACR policy priorities and agency agendas.
With the state legislative session in full swing, the ACR is currently tracking 114 pieces of state legislation across many issue areas, including utilization management, prescription drug review boards and vaccines.
With Mehmet Oz, MD, expected to be confirmed as administrator of the Centers for Medicare & Medicaid Services, the ACR considers how his stated priorities may affect rheumatology.
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.
These events will provide a critical opportunity for patients, caregivers, patient organizations, clinicians and researchers to offer input on the drugs selected for the second cycle of negotiations.
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.
As state legislatures begin to convene their sessions in 2025, several key issues related to rheumatology are expected to take center stage, including drug costs, utilization management, telehealth and copay accumulators.