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.
Articles tagged with "ACR advocacy"
SAN DIEGO—In an advocacy update session at ACR Convergence 2023, ACR staff described progress in multiple priority areas, including access to care and workforce issues.
On July 13, the Centers for Medicare and Medicaid Services released the CY 2024 Medicare Physician Fee Schedule Notice of Proposed Rulemaking. This annual rule outlines policies related to provider reimbursement, coverage of telehealth services, review of specific codes, refinement of evaluation and management codes and updates to the Quality Payment Program.
As health insurance companies and third-party benefit managers continue to use copay accumulators and maximizers to shift the cost of specialty drugs to patients, the ACR continues to advocate against programs that limit copay assistance.
Two ACR-led resolutions on in-office specialty drug dispensing and the proposed NIH Public Access Plan passed the House of Delegates and will become AMA policy.
After significant pushback from the AMA, ACR and other medical societies, Cigna has delayed implementation of changes to its modifier 25 reimbursement policy, originally scheduled to take effect May 25.
This legislative season has seen key pharmacy benefit manager reforms but slow movement on other issues, such as copay accumulators and utilization management. The ACR is also monitoring emerging topics, such as biomarker testing and post-public health emergency telehealth reforms.
Nearly 70 rheumatologists and rheumatology professionals convened in Washington, D.C., to advocate on behalf of legislation that would preserve and help to grow America’s healthcare workforce.
In April, the Medicare Payment Advisory Committee voted to recommend a change in the add-on payment for Part B drugs, including reducing payment for more expensive drugs. The ACR sent a letter to MedPAC expressing concerns about the significant impacts such policies would have on rheumatologists.
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.