Earlier this month, the House Ways and Means Committee reported out a two-year extension of telehealth flexibilities, which the physician community broadly supports. The legislation also included a “delinking” provision as an offset to help pay for the telehealth extension.

As the name implies, delinking would sever the connection between a drug’s price and pharmacy benefit manager (PBM) income, requiring flat fee compensation instead. That would correct one of the major perverse incentives underlying our current drug pricing and access system, whereby drugs with higher list prices have higher income potential for the PBM, who negotiates percentage-based price concessions off the list price.

Unfortunately, the provision reported out by Ways and Means includes a loophole that would seemingly still allow PBMs to rely on percentage-based price concessions, with little practical change from the current system. CSRO will continue to push for the strongest possible delinking policy in any end-of-year PBM reform package.

CSRO continues to receive reports from practices around the country about certain biosimilars’ acquisition costs exceeding reimbursement. Over the last few weeks, CSRO has requested feedback from the rheumatology community to help quantify the problem – thank you to all who shared their input.

Using this data, CSRO has created a resource document to aid the rheumatology community in addressing this issue with payers and illustrate the extent of the problem. Read our explanatory statement here.

CSRO's Vice President of Advocacy & Government Affairs Dr. Madelaine Feldman discusses the financial challenges rheumatologists are facing due to the acquisition cost of certain biosimilars exceeding reimbursement levels.

Read more in the latest edition of Rheum for Action, CSRO's advocacy column authored by Dr. Madelaine Feldman and produced in partnership with Rheumatology News (PDF available here).

CSRO’s virtual Business of Rheumatology seminar series to help support rheumatology practices in building and strengthening their business has returned!

Log in on Wednesday, July 31, to explore if larger groups, including super groups, are the way forward to maintain private practice in rheumatology through a panel discussion of representatives from Arizona Arthritis and Rheumatology Associates, Articularis Healthcare, Bendcare, and United Rheumatology/Specialty Networks.

Insurers and pharmacy benefit managers have long waged a war against copay assistance through accumulator adjustment and copay maximizer programs. Now, a new tactic has entered the mix – alternative funding programs.

In an effort to better inform employers about these programs, CSRO Vice President of Advocacy & Government Affairs Dr. Madelaine Feldman joins nine other co-authors in this HR.com article Alternative Funding Programs: What Employers Need to Know.

Iowa recently signed two CSRO-supported bills into law; a non-medical switching bill and a biomarker testing bill. The non-medical switching legislation has been debated in the legislature for years, and now that it is enacted, will prevent insurers from forcing patients to switch medications during the course of a plan year if they are already stable on an existing drug.

The biomarker testing bill will help those tools be more accessible for rheumatologists as the technology emerges and matures for the specialty. While many insurers cover biomarkers tests, the legislation will ensure that coverage and access are predictable and consistent by requiring coverage of a test if it has met certain validation criteria.

The support of the Iowa rheumatology community was instrumental in the successful outcome of both of these bills. In particular, the testimony of CSRO Board member and Rheumatology Association of Iowa (RAI) member Dr. Michael Brooks (pictured above) was crucial in convincing lawmakers that the biomarker bill, which was originally limited to products only used by oncologists, should be expanded to cover all types of biomarkers regardless of targeted disease.

Stay tuned for additional details and resources on CSRO's map tool.

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients. Check out the list below to see the status of CSRO priority bills from the past two weeks, and click here to view a full status report of CSRO priority bills.

Be sure to check out our interactive legislative map tool for additional details.

California

Accumulators

• AB 2180: On Appropriations committee suspense file

Colorado

White Bagging

• HB 1010: Amended to oncology only and delivered to the Governor

Iowa

Biomarker Testing

• HF 2668: Signed by the Governor

Non-medical Switching

• HF626: Signed by the Governor

Louisiana

Alternative Funding Programs

• HCR 96: Approved by committee 

Maine

Biomarker Testing

• LD1577: Vetoed by the Governor

Rhode Island

Prescription Drug Affordability Board

• H8220: Committee recommends measure be held for further study
• S2719: Approved by committee

Vermont

Utilization Management Reform

• H766: Delivered to the Governor

Prescription Drug Affordability Board

• S98: Senate concurs with House amendments 

Virtual Advocacy Day: July 10, 2024

Advocate alongside CSRO as we host live conversations with health care leaders from the U.S. Senate and U.S. House of Representatives.

Business of Rheumatology: July 31, 2024

CSRO's virtual seminar series to help support rheumatology practices in building and strengthening their business.

CSRO Advocacy Conference: September 20-22, 2024

Gather with others in the rheumatology community in Nashville for CSRO's annual Advocacy Conference! 

State Society Conferences:

CSRO's state rheumatology society members host their own annual meetings throughout the year. Find a listing of these state-specific conferences on our website.

Action Center

Use CSRO's convenient online platform to easily find out who your elected officials are and engage with them directly.

Advocacy Council

Amplify your voice by assembling with other like-minded individuals to enhance CSRO’s advocacy initiatives.

Career Center

Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.

Legislative Map Tool

Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.

Payer Issues Reporting Form

Request assistance with any payer relation issues that may be impacting your patients or office.

Policy Correspondence

Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.

Rheum for Action

Learn about the latest advocacy issues in CSRO's advocacy column authored by Dr. Madelaine Feldman and produced in partnership with Rheumatology News.

Step Therapy Cover Sheets

Review CSRO's state-specific step therapy materials that help guide practices in gaining an exemption from step therapy protocols.

Questions?

Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at info@csro.info.