Today is Rheumatoid Awareness Day: Help Raise Awareness by Taking Action

Held annually on February 2, Rheumatoid Awareness Day helps raise awareness for the 1.5 million Americans who function daily with rheumatoid disease, also known as rheumatoid arthritis.

Advocacy can have a tremendous impact to improve a patient's quality of life and is a critical component of CSRO's mission. In honor of this day, we invite you to advocate by raising awareness!

TAKE ACTION: Invite your state legislators to visit your office to help them better understand that rheumatology patients suffer when they are not protected from utilization management practices.

With just a few keystrokes, CSRO's Action Center will automatically select your elected official and you can then use our pre-populated template message to invite them to visit your office. Then, if you schedule a meeting, email us at info@csro.info and we will provide talking points and information to share.

Advocacy = Awareness – join us in taking action today.

Status Update: CMS "Pause" on Downcoding

CSRO remains in contact with CMS headquarters regarding challenges with billing and coding for drug administration services. According to CMS, the August 12, 2022 Technical Direction Letter (TDL) remains in effect, although guidance from local Medicare Administrative Contractors (MACs) may continue to direct practices to use “simple” administration codes for complex infusions and injections.

Please continue to contact CSRO at info@csro.info with claim denials from your local MAC that are inconsistent with the TDL.

Advocating for You: CSRO Urges Improvements in Exchange Plan Policies

In comments to the Centers for Medicare and Medicaid Services (CMS), the Alliance of Specialty Medicine, of which CSRO is a founding member, urged the agency to improve consumer access to specialty physicians and medication therapies in Exchange plans established under the Affordable Care Act (ACA).

Specifically, the Alliance called on CMS to address flawed network adequacy criteria, which do not account for many specialty and subspecialty providers. They also expressed support for CMS’ proposal that would require plans to place all covered drugs in the appropriate cost-sharing tiers (i.e., generic drugs in the generic tier, brand drugs in the brand or specialty tiers) unless there is a clinical basis for doing otherwise, and to make the evidence for such determinations available for public review. The full letter is available for review here.  

Biomarker Testing Coverage: A New Policy Issue for 2023

Biomarker testing is an emerging clinical tool that can help rheumatologists more effectively get their patients on the right therapy in an efficient manner. While biomarker testing technologies are more mature for diseases treated by other specialties, such as oncology, rapid innovation is occurring and rheumatologists may begin to see the deployment of these technologies in their practices in the near future.

Of course, ensuring the tests are scientifically sound is only part of the battle. As with any emerging clinical tool or treatment, ensuring access via coverage is another piece of the puzzle. In order to get ahead of the curve, CSRO is supporting legislation across the states that require the coverage of biomarker testing if a test is supported by scientific evidence such as nationally recognized clinical practice guidelines, CMS or MAC coverage determinations, or labeled indications or indicated tests for a drug approved by the FDA.

Since 2002, CSRO has been advocating for access to the highest quality care for patients with rheumatic disease, and we believe supporting this legislation will better enable rheumatologists to diagnose conditions. So far this year, Colorado, Georgia, Massachusetts, New Mexico, New York, Oklahoma, and Washington have filed biomarker testing coverage legislation – visit CSRO’s map tool to learn more.

Happening Next Week: Advocacy Insider Part 2

You don’t need to be an expert on policy to be involved in advocacy!

Log in next week, February 8, for the second installment of our Advocacy Insider series to learn from former Congressional health policy staff about what stands out in conversations and why it’s important for elected officials to hear from you, their constituents.

Plus, receive insights directly from a rheumatologist about their experiences successfully advocating for change, followed by an overview of anticipated opportunities for engagement in state activity in 2023. We hope to see you there – sign up now!

Rheum for Action: Unintended Consequences of Perfectly Good Programs and Policies

CSRO's Immediate Past President and Vice President of Advocacy & Government Affairs, Dr. Madelaine Feldman, discusses the unintended consequences of certain healthcare policies and programs that have led to abuse and negative downstream effects on the same population that they were intended to protect.

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

ICYMI: Opportunity For Action in Your State

The following states have active legislation that needs your support – make your voice heard today: 

• New Mexico – Biomarker Testing & Accumulators
• Take Action: HB 73
• Take Action: SB 51
• Oregon – White Bagging
• Take Action: HB 2715
• Virginia – Rebate Pass Through
• Take Action: HB 1782 & SB 1425
• Washington – Rebate Pass Through
• Take Action: SB 5445 & HB 1465

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients – click here to view a full status report.

Be sure to check out our interactive legislative map tool for additional information about current policy in your state.

What's Happening in the Capitol

In January, Senators Cantwell (D-WA) and Grassley (R-IA) reintroduced two PBM-related bills from the previous Congress. The Prescription Pricing for the People Act (S. 113) would require the Federal Trade Commission (FTC) to study pharmaceutical supply chain intermediaries and merger activity and the effect on competition. The FTC study must include a review of formulary design. Since this legislation was first introduced in the last Congress, the FTC has begun a study of the PBM industry, but the bill sponsors believe that a thorough study of the entire supply chain remains necessary, since the current FTC study specifically focuses on six large PBMs.

Additionally, the Pharmacy Benefit Manager Transparency Act (S.127) includes a pass-through provision in addition to several pharmacy-focused reforms. Specifically, the bill would create a presumption of unfair and deceptive practices by a PBM, unless the PBM passes through 100% of any rebate to the health plan/payer and meets specified disclosure requirements. The fact that the pass-through would flow to the payer instead of the patient makes the legislation less exciting for us, but the early introduction of two bipartisan bills by experienced Senators is a welcome indicator of the prioritization of PBM oversight and reform in the new Congress.

CSRO will continue to monitor and provide updates as appropriate.

Advocacy Insider Part 2 - Making it Happen: February 8, 2023

Join CSRO for the second installment in our new webinar series highlighting what advocacy really is and the simple things you can do to make a positive impact.

CSRO's Fellows Conference: March 10-11, 2023

Help rheumatology fellows as they prepare for their future roles as physicians by encouraging them to attend CSRO's 2023 Fellows Conference – an annual event curated by rheumatologists specifically for rheumatology fellows. Registration closes February 8.

Regional Town Halls: Mondays in April & May

Interested in learning more about what is going on in your state? Join us to network with your community members and hear advocacy updates specific to your area.

CSRO's Advocacy Conference: August 25-27, 2023

Mark your calendars to join us in Austin for CSRO's Advocacy Conference and celebration of our 20th Anniversary! 

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• Request assistance with any payer relation issues that may be impacting your patients or office.
• 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.
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• Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.
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