WASHINGTON, D.C.—Dozens of rheumatology leaders met with more than 100 politicos on Capitol Hill in mid-May as part of the ACR’s annual Advocacy Leadership Conference. Armed with research and advocacy training concerning a handful of important issues, rheumatologists, rheumatology interprofessional team members, government affairs specialists and others met with federal lawmakers, legislative aides and correspondents….
As the practice of step therapy grows more pervasive throughout the insurance industry, the protocols become increasingly confusing to navigate. Steps vary from insurer to insurer based on plan type, and formulary differences are too often based on economic incentives rather than outcome-based medicine. Patients are often left hanging in the balance while physicians’ offices…
So far it has been a busy year for the Affiliate Society Council (ASC). Forty-three states are now affiliated with the ACR through the ASC, and we may add another next year. Also, many state legislative sessions have wrapped up, so it’s a great time to provide an overview of the successes—and some of the…
Broken hips are among the most serious injuries incurred by older adults, and many fractures are preventable. According to the Centers for Disease Control and Prevention (CDC), approximately 300,000 people over the age of 65 are hospitalized each year for hip fractures, with women (who have lower bone density than men) experiencing three-quarters of all…
Take the challenge. C—When an insurance carrier requests the medical record for a service performed, the practice should send all pertinent information to support the medical necessity of that service. For example, if the drug requires that a patient first be tested for tuberculosis and the patient should be on methotrexate or leflunomide, the note…
A private insurance carrier sends an audit request letter to a rheumatology practice to review its infusion medical records for the past 30 dates of service. What information should the practice send to the carrier? Only the infusion notes The complete notes for the requested dates of service only The complete notes for the requested…
We have often heard it said that opportunity arises from challenges. Challenge, of course, is really just a polite way of saying problem—and for our patients, problems abound when it comes to obtaining timely and affordable access to the rheumatologic care they need. Access in this context has many meanings: There is access to life-changing…
An integral part of the rheumatology care team, social workers can address specific issues related to a patient’s overall wellbeing. Here are some insights into how rheumatologists can better partner with social workers as part of the interdisciplinary team to ensure better patient outcomes…
In August 2018, the Centers for Medicare and Medicaid Services (CMS) announced it would permit Medicare Advantage plans to use step therapy for Part B drugs, with a lookback period of just 108 days.1 On May 16, 2019, however, the CMS issued a final rule that extends the lookback period for Part B therapies to 365…
TORONTO/MONTREAL (Reuters)—The Canadian province of British Columbia said on May 28 that its public drug plan will switch as many as 20,400 patients from three branded biologic drugs to cheap near-copies called biosimilars, saving an estimated C$96.6 million ($71.9 million) over three years. The new policy from the province’s PharmaCare program targets Johnson & Johnson’s…