On Feb. 1, UnitedHealthcare enacted a new policy designating Avsola and Inflectra as the preferred infliximab products for UHC commercial plans. ACR leaders have urged UHC to allow existing patients to continue on their current medication.
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UnitedHealthcare Delays Copay Accumulator Policy
After ACR and other provider and patient organizations expressed concerns about a proposed copay accumulator policy set to take effect Jan. 1, 2021, UnitedHealthcare has indefinitely delayed its implementation but is continuing to explore options to reduce spending on specialty drugs.
The Prescription for a Healthy Rheumatology Practice
As practice administrator for the past nine years at Emerald Coast Rheumatology in Lynn Haven, Fla., Andre Smith has worked to expand what was a single-provider, three-employee practice into an 8,000-square foot rheumatology clinic and 18-chair infusion center with two additional providers. Although not all rheumatologists have a practice administrator on staff, those who do…
ACR Urges Commercial Payers to Cover Telemedicine Beyond the Public Health Emergency
In a letter sent to commercial payers, the ACR’s Insurance Subcommittee is advocating for continued coverage for telemedicine, including reimbursement parity, after the end of the declared public health emergency.
UnitedHealthCare Rescinds Planned Changes to Orencia Policy
UnitedHealthcare (UHC) is rescinding changes to its Orencia policy previously scheduled to go into effect July 1, 2020. These changes would have required patients to fail to respond to the self-administered formulation of the drug prior to obtaining authorization for the physician-administered product. Some patients on Orencia received notices from UHC in late April stating…
UnitedHealthcare to Implement Fail-First Requirement for Self-Administered Orencia
On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product. The ACR has been in communication with UHC about this policy since October 2019, when the payer…
Commercial Insurers Extend Coverage for Telehealth Services
The ACR has created a chart of temporary changes to commercial payers’ telehealth policies that make it easier for physicians and patients to connect without the need for an office visit.
Experts Discuss Current Insurance Issues Challenging Rheumatology
ATLANTA—From step therapy requirements to infusion center locations to evaluation and management coding, insurance issues bring frequent headaches to clinicians and patients. Experts discussed some of the most recent concerns in a session at the 2019 ACR/ARP Annual Meeting. Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee (ISC), and Gary Bryant, MD, delegate to…
The ACR Introduces a New Reproductive Health Guideline
Reproductive health can be a concern for patients with rheumatic diseases, and practitioners in both rheumatology and obstetrics/gynecology often work closely together. The 2020 ACR Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases, new clinical recommendations developed by an ACR-convened group for pregnant women, post-menopausal women, lactating women, and women and…
The ACR Introduces New Reproductive Health Guideline
The evidence-based guideline includes contraceptive recommendations and suggestions for rheumatologists co-managing patients with obstetrician-gynecologists and other specialists.
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