The updated draft guidance, released in June, would accept an assessment of why data provided meet the switching standard to demonstrate interchangeability of biosimilars
ACR-Led Coalition on Underwater Biosimilars Grows, Charts Next Steps
New members include rheumatology state societies, specialty partners in gastroenterology and patient-facing organizations representing digestive and inflammatory diseases. The ACR and coalition partners are strategizing additional steps to ensure practices receive adequate reimbursement for biosimilars.
Urge Your Lawmakers to Support Critical Medicare Payment Reform
The recently introduced Physician Fee Stabilization Act (S. 4935) would raise the budget neutrality threshold from $20 million to $53 million and help alleviate the annual uncertainty providers face surrounding Medicare reimbursement rates.
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.
Summary of Notable Provisions in CY 2025 Medicare PFS Proposed Rule
The ACR will provide comments on several provisions related to Medicare physician payment and the Quality Payment Program.
ACR Applauds Legislation to Reform Prior Authorization Policies
A new bill, the Improving Seniors’ Timely Access to Care Act, aims to streamline the prior authorization process. “The prior authorization process has become unmanageable for both doctors and patients. Insurer red tape imposes a significant burden on clinicians, leading to unnecessary and unclear delays, or even outright denials of patient care,” says ACR President…
ACR Successfully Leads Coalition in AMA House of Delegates to Support Higher Pediatric Specialist Compensation
An ACR-led resolution that calls for Medicaid payment parity for pediatric specialists will become AMA policy.
Pharmacy Benefit Managers Under Scrutiny
“When pharmacy benefit managers [PBMs] came into being 30 years ago, they were seen as an important component of the prescription distribution system [because] they could guide benefits and money between the patient, pharmacy and the manufacturer,” says Angus Worthing, MD, president of the Alliance for Transparent & Affordable Prescriptions (ATAP). Health insurance companies hire…
ACR Delegation to Lead Several Resolutions at June AMA House of Delegates Meeting
The ACR will lead five other specialty societies on a resolution supporting pediatric specialty care and will co-lead resolutions addressing Medicare Advantage Part B drug coverage, white bagging mandates, state prescription drug affordability boards and impacts of alternative funding programs on access to care.
Commercial Payers Update Reimbursement for Underwater Infliximab Biosimilars
Three commercial health insurance payers have increased reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
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