The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices, including issues related to biosimilar use, in-office treatments and the new G2211 code.
The Biosimilar Economic Conundrum: Where We Stand
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.
Updates from the ACR Insurance Subcommittee Chair
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices. Recent activities include efforts to avoid increased administrative burden associated with specialty medications, support payer coverage of musculoskeletal ultrasounds and protect patient access to biologics.
The ACR Opposes New AI-Based Decision-Making Platform
On July 1, Blue Cross Blue Shield of North Carolina introduced a machine-learning technology platform to make decisions about patients’ care and treatment. The ACR opposes its use on grounds that it may harm patients’ access to treatment and undermine the doctor-patient relationship.
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.
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
Advocacy Leadership Conference: Reflections from an Accidental Rheumatology Advocate
At my first Advocacy Leadership Conference as a member of the ACR’s Insurance Subcommittee, I discovered the power of stories from the clinic and how lawmakers value clinicians’ input on healthcare legislation.
Update from the ACR Insurance Subcommittee
The ISC has worked with CVS Caremark to revisit changes to its prior authorization forms that would have increased the administrative burden on practices, and patients with Blue Cross Blue Shield of South Carolina may not have to worry about switching to a self-administered biologic.
ACR Insurance Subcommittee Chair Encourages Member Engagement
Rheumatology practices have a voice in payer advocacy through the Insurance Subcommittee of the ACR’s Committee on Rheumatologic Care.
Why Community Rheumatologists Serve: Committee Work Pays Off ‘Many Times Over’
Volunteer leaders who are community rheumatologists share their thoughts about the professional and personal benefits of serving on ACR committees and encourage others to get involved.