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.
ACR Advocacy Staff Outline Victories, Challenges from a Busy Year
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.
CMS Proposes Reimbursement Cuts for CY24
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.
Copay Accumulator & Maximizer Programs Threaten Access to Treatment
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.
Rheumatology Priorities Advanced at Busy AMA House of Delegates Meeting
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 Pushback, Cigna Delays Modifier 25 Policy Changes
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.
Slow but Steady: 2023 State Legislative Progress
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.
ACR Hill Day Participants Ask Congress to Address Medical Workforce Shortage
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.
ACR Expresses Concerns with MedPAC’s Drug Pricing Recommendations
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.
ACR Insurance Subcommittee Tackles Known Issues
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.
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