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Search results for: health insurance

State Copay Accumulator Legislation: An Overview

Joseph Cantrell, JD  |  June 25, 2024

As uncertainty persists around federal policies regarding copay accumulator programs, a growing number of states are stepping in. A total of 21 states have banned the programs and others are increasing transparency requirements

Filed under:Uncategorized Tagged with:copay accumulatorsstate legislation

Ethics Forum: Regarding Chatbots in Rheumatology

Biana Modilevsky, DO, & Kabita Nanda, MD  |  June 10, 2024

Chatbots are not a new concept, but have recently gained popularity and traction. Launched in late 2022, ChatGPT (Chat Generative Pre-Trained Transformer) is a web-based platform designed to simulate interactive conversations and deliver real-time data. It has quickly become a tool that provides instantaneous information that can be more focused than a Google search.1 We,…

Filed under:EthicsInsuranceTechnology Tagged with:artificial intelligencechatbotsEthics ForumHIPAA

Pharmacy Benefit Managers Under Scrutiny

Elizabeth Hofheinz, MPH, MEd  |  June 10, 2024

“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…

Filed under:Drug UpdatesLegislation & Advocacy Tagged with:drug pricingdrug pricing transparencypharmacy benefit managers (PBMs)

Ethics Forum: The Current Landscape of Artificial Intelligence in Medicine

Jeanne Gosselin, MD  |  May 6, 2024

A handful of articles on artificial intelligence (AI) have graced the pages of this publication in the past six years, including one by Bharat Kumar, MD, in November 2022. Dr. Kumar highlighted the exciting potential of AI in rheumatology, including machine learning (ML) algorithms for the prediction of response to methotrexate and a predictive model…

Filed under:EthicsPractice SupportTechnology Tagged with:artificial intelligenceDiagnosisEthics Forum

Focus on Community Practice Rheumatology

Vanessa Caceres  |  March 14, 2024

Community practice rheumatology brings with it certain challenges, but it also offers rewards, such as autonomy and the capacity to develop deep relationships with patients. Three rheumatologists discuss the challenges and rewards of private practice.

Filed under:American College of RheumatologyOpinionPractice ManagementPractice Support

The Biosimilar Economic Conundrum: Where We Stand

Carina Stanton  |  January 17, 2024

Reimbursement has fallen below acquisition price for some biosimilar versions of infliximab, forcing practices and patients to make difficult decisions. The ACR is working to change this.

Filed under:InsuranceLegislation & Advocacy Tagged with:ACR advocacyACR Insurance Subcommittee (ISC)Biosimilars

Community Practice Rheumatology Is Challenging, But Rewarding, Too

Vanessa Caceres  |  January 10, 2024

Community practice rheumatology may be a less-followed path within the specialty, and it brings with it certain challenges. However, it also offers rewards, such as autonomy and deep relationships with patients. The Rheumatologist recently interviewed three community practice rheumatologists from around the U.S. to find out about their approaches to patient management, staffing and other…

Filed under:Billing/CodingPractice SupportTechnologyWorkforce Tagged with:Advanced Practice Clinicianscommunity practiceprior authorizationstaffingtelemedicine

Pregnancy Outcomes in Patients Treated with TNF Inhibitors

Michele B. Kaufman, PharmD, BCGP  |  December 18, 2023

A study found the continuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with chronic rheumatic inflammatory diseases after pregnancy diagnosis was not associated with worse outcomes than those who discontinued treatment with TNFi’s.

Filed under:ACR ConvergenceBiologics/DMARDsConditionsDrug UpdatesMeeting Reports Tagged with:ACR Convergence 2023pregnancypregnant womentumor necrosis factor inhibitor (TNFi)

Experts Highlight Key Issues Impairing Access to Care

Thomas R. Collins  |  December 12, 2023

Speakers discussed common payer practices and policies that rheumatologists must navigate to secure and maintain appropriate care for their patients, including pharmacy benefit managers and prior authorization.

Filed under:ACR ConvergencePractice Management Tagged with:Access to care

Striving for Equity

Glen Rodman  |  December 5, 2023

SAN DIEGO—At ACR Convergence 2023, panelists provided guidance for reducing disparities and improving health equity for patients who are negatively impacted by social determinants of health.

Filed under:ACR ConvergenceGuidanceLegislation & AdvocacyLegislation & AdvocacyMeeting ReportsProfessional Topics Tagged with:ACR Convergence 2023Equity

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