A coalition of patient and provider groups, including the ACR, is raising awareness about the effect of pharmacy benefit managers (PBMs) on patient care and the cost of prescription drugs. The Alliance for Transparent and Affordable Prescriptions, or ATAP, argues that too few restrictions have been placed on PBM transparency, and requirements for PBMs to…
Advocating for CMMI Reform, Looking Ahead to Alternative Payment Models
The work of health policy reform is a marathon, not a sprint. The ACR is encouraged by the forward progress being made in collaboration with the American Medical Association and other physician-led organizations within the Healthcare Leaders for Accountable Innovation in Medicare and Medicaid coalition (known as the AIM coalition) to advocate for physicians’ ability…
Aetna CEO Urges Debate on What ‘Single-Payer’ Healthcare Would Be
NEW YORK (Reuters)—Aetna Inc, Chief Executive Officer Mark Bertolini wants a debate about what a single-payer healthcare system in the U.S would look like, but says he does not think the federal government should run it. “I think government-run healthcare would be a bad idea,” Bertolini says during an investor conference on Frida. The government’s…
Aetna Fully Exits Obamacare Exchanges with Pull-Out in 2 States
(Reuters)—Health insurer Aetna Inc said on Wednesday it will exit the 2018 Obamacare individual insurance market in Delaware and Nebraska – the two remaining states where it offered the plans. Aetna had already said it would exit the individual commercial market in Virginia and Iowa, after pulling out of several other states last year. Aetna…
Republican Moves on Obamacare Cloud Insurers’ 2018 Plans
NEW YORK (Reuters)—U.S. Republicans may be moving ahead with a vote to repeal Obamacare, but the uncertainty about what a national health law may look like is clouding insurers’ decisions on whether to stay in the individual insurance market in 2018. Republicans do plan to vote on the U.S. House of Representatives bill, the American…
Arthritis Awareness Month: 5 Ways to Get Involved
In early March, the Centers for Disease Control and Prevention (CDC) released a new report showing that the number of Americans living with arthritis is at an all-time high. According to the report, 54 million Americans now live with arthritis, and approximately 79 million will have arthritis by 2040. This stark picture comes at a…
CMS Notifying Clinicians of Their MIPS Status
According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Administrative Contractors (MACs) that process Medicare Part B claims have begun informing providers of their participation status in the Merit-Based Incentive Payment System (MIPS). This information is coming in the form of hard-copy letters that started mailing in late April and will continue…
Institute for Clinical Economic Review Final Report on RA Treatments
On April 7, 2017, the Institute for Clinical and Economic Review (ICER) published its final report, titled, Targeted Immune Modulators for Rheumatoid Arthritis: Effectiveness & Value.1 The stated objective of the report was to assess the comparative clinical effectiveness of the targeted immune modulators (TIMs) used to treat patients with moderate to severe active rheumatoid…
Noridian Updates Tendon Injections Guidelines for Jurisdiction F
Effective May 22, 2017 Noridian has updated the Local Coverage Determination (LCD) coding guidelines for CPT procedures 20552, injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) and 20553, injection(s); single or multiple trigger point(s), 3 or more used to affect therapy for a pathological condition. Noridian states the goal of the updated diagnostic…
Step Therapy and Biosimilar Substitution Top the Priority List for the Rheumatology Association of Iowa
A little more than three years ago, rheumatologist Michael Brooks, MD, FACP, FACR, Cedar Rapids, Iowa, turned years of discussion into something tangible: He and his colleagues got the paperwork and financial requirements in order and officially started the Rheumatology Association of Iowa. “We had been trying to get something going statewide in terms of…
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