This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
Since the beginning of the year, the ISC has sent eight letters to payers in response to problematic policies. Each letter outlines the ACR’s concerns and requests corrective action…
If you are a news junkie, then you know that a tick-tock is a story that relies heavily on chronology, counting down the events of the day, in order, as inexorably as the ticking clock. These types of timeline stories have become very popular in the fast-paced world of modern politics, in which readers eat…
Greetings, Advocates! Great news for the rheumatology community came on Feb. 9, when the Bipartisan Budget Act of 2018 was enacted. It contains several critical healthcare fixes pertinent to rheumatology. First, after hundreds of emails, meetings, letters to the editor, an op-ed, and a forceful 109-member coalition (led by the ACR and including many state…
On Dec. 20, 2017, Congress passed a massive tax bill that will have an impact on nearly every individual and business in America. The bill makes sweeping revisions to existing tax provisions, and it will largely affect the health industry. Individual Mandate Repealed The bill repeals the individual mandate established in 2005 by the Affordable…
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
WASHINGTON (Reuters)—United States health spending is projected to rise 5.3% in 2018, reflecting rising prices of medical goods and services and higher Medicaid costs, a U.S. government health agency said on Wednesday, an upward trend it forecasts for the next decade. The increase represents a sharp uptick from 2017 spending, which the U.S. Centers for…
(Reuters)—After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions. Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the U.S.s’ huge over-65 health…
NEW YORK (Reuters)—Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co. said on Tuesday they will form a company to cut health costs for hundreds of thousands of their employees, setting up a major challenge to an inefficient U.S. healthcare system. The move by three of the best-known U.S. business leaders—Amazon’s Jeff Bezos, Berkshire’s…