The Insurance Subcommittee is working on behalf of ACR members to address underwater formulary requirements for biosimilars, mandated switches to biosimilars, evaluation and management downcoding and more.
Search results for: biosimilars
How NIH, FDA Nominees May Affect Rheumatology
The nominations of Jay Bhattacharya, MD, PhD, as director of the National Institutes of Health and Martin Makary, MD, MPH, for commissioner of the Food & Drug Administration have the potential to significantly impact federally funded healthcare research, federal responses to public health emergencies and federal regulation of drugs and medical devices.
ACR Comments on Proposed Medicare Advantage Changes
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.
Hit the Ground Running with New Insurance Subcommittee Chair Michael Feely, MD
Dr. Feely discusses his previous work with the College, his current work as a practicing rheumatologist and how he will lead continued advances on the insurance front.
A Look Back at 2024 Regulatory Developments
In 2024, key federal healthcare regulations and policy developments—related to health insurance, privacy protections, reimbursement, biosimilar use and more—shaped the landscape of the practice of rheumatology in several important ways.
Voice of Rheumatology Coalition Meeting: Enhancing Collaboration
The Voice of Rheumatology (VOR) Coalition convened last month at ACR Convergence 2024 in Washington, D.C., to discuss the pressing federal and state legislative priorities that will affect both the practice of rheumatology and patient care in the year ahead. The Coalition, composed of leading rheumatology professional societies and patient advocacy groups, gathered to examine…
The Ethical Tug-of-War Over Biosimilar Adoption
The advent of biosimilar medications has offered the promise of significant cost savings for healthcare systems and patients. Biosimilars are highly similar versions of existing biologic drugs, providing a more affordable alternative once the original biologic patent expires. However, the adoption of biosimilars in the U.S. has been hampered by myriad roadblocks, many of which…
FDA Officials Discuss Extrapolation & Confusion Around Pediatric Therapies
A session at ACR Convergence 2024 addressed several recent drug approvals in pediatric rheumatology and a safety update for IL-1/IL-6 inhibitors.
Unless Congress Acts, Medicare Reimbursement Will Remain Flat or Drop in 2025
The 2025 Medicare Physician Fee Schedule final rule, released Nov. 1, includes a conversion factor of $32.3465, a 2.83% drop from 2024. In response to advocacy efforts from the ACR and other medical societies, Congress recently introduced the Medicare Patient Access and Practice Stabilization Act of 2024, which would eliminate the 2.83% payment cut and provide an inflationary update for 2025 equal to 50% of the Medicare Economic Index.
Updates from the ACR Insurance Subcommittee
The ACR Insurance Subcommittee (ISC) of the Committee on Rheumatologic Care has been hard at work, advocating to payers on behalf of the ACR and its members. Following is an update on some of the work this group has been doing to help address concerns about reimbursement and administrative burden, while ensuring continued access to…
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