CSRO recently led a multispecialty letter to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz urging reform of the Medicare Self-Administered Drug (SAD) Exclusion List – a follow-up to CSRO’s letter to former Secretary Becerra in September 2024. Medicare’s SAD List policy continues to hinder access to Medicare Part B coverage for physician-administered versions of medications that some patients cannot reasonably self-administer, particularly for beneficiaries with physical or cognitive limitations.

CSRO and its provider and patient partners emphasized that the SAD List increases waste and Medicare spending – issues the new administration has said it intends to address – and undermines physician decision making. The organizations also highlight how SAD-related policies drive higher costs by shifting care into more expensive settings and expose patients to unnecessary out-of-pocket expenses, urging Medicare to revisit its SAD List criteria and direct its administrative contractors to improve the approach to SAD List determinations.

Last week, in testimony submitted to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, CSRO outlined how rebate-driven ASP distortions and Medicare Advantage step therapy requirements are making many biosimilars financially unviable for physicians to administer and threatening patient access to needed medications. Through its testimony and a stakeholder letter signed by over 40 national and state organizations, CSRO emphasized the need for Congress to direct CMS to assess these issues and to revise step therapy policies to ensure they do not further compromise care for Medicare beneficiaries. 

At its April 2025 public meeting, the Medicare Payment Advisory Commission (MedPAC) voted to approve two draft recommendations aimed at strengthening the Medicare Physician Fee Schedule (PFS) and improving payment accuracy – that will be included in their June 2025 Report to the Congress. The first recommendation would replace current-law PFS updates with an annual increase based on a portion of the Medicare Economic Index (MEI), such as MEI minus 1 percent, to provide more stability while balancing fiscal pressures. The second would direct CMS to improve the accuracy of relative value units (RVUs) by collecting and using timely cost data to better reflect the actual expenses of delivering clinician services. While these recommendations are a step in the right direction, the physician community is urging Congress to provide a more robust payment update tied to the full MEI, not just a portion. For rheumatologists, the continued failure to appropriately value cognitive work also remains a concern that continues to be shared with policymakers. 

U.S. Representatives Lloyd Doggett (D-TX) and Greg Murphy, MD (R-NC) sent a letter to the Comptroller General of the United states urging the Government Accountability Office (GAO) to conduct an investigation into the growth of Medicare Advantage health plans and the plans payments to providers under the insurers’ ownership. Doggett and Murphy questioned whether the privately run Medicare Advantage plans skirt federal requirements on Medical Loss Ratio, which require plans to spend at least 85 percent of revenue on health care for enrollees. Over 33 million patients are currently enrolled in Medicare Advantage plans, which cost the federal government more than $450 billion in 2023.

Advocacy in Action: Testimony in South Carolina Before House PBM Ad Hoc Committee on Pricing & Patient Affordability

CSRO Vice President of Advocacy & Governemnt Affairs Dr. Madelaine Feldman was recently invited by South Carolina State Representative Health Sessions to testify before the South Carolina House PBM Ad Hoc Committee, in which she provided committee members education on critical issues surrounding prescription drug pricing and the role of Pharmacy Benefit Managers (PBMs) in the healthcare system.

During her testimony, which begins at the 1 hour 40 minute mark of the recorded session available here, Dr. Feldman detailed the tactics employed by PBMs to steer patients toward certain medications and specialty pharmacies for their financial gain. She highlighted how these practices can impact patient access to necessary treatments, ultimately affecting health outcomes and driving up costs for consumers.

As the South Carolina legislature grapples with critical healthcare issues, Dr. Feldman's insights are particularly timely. South Carolina recently filed a step therapy/prior authorization bill, as well as legislation addressing accumulators and maximizers, and a PBM reform bill focusing on pharmacy related issues. The committee is set to reconvene on April 22.

Medicare Advantage & Part D: Their Impct on Private Practice

CSRO's Business of Rheumatology series was designed to help support rheumatology practices in building and strengthening their business. Sign up today to join us on Wednesday, May 14, at 7pm CT / 8pm ET for our next seminar focusing on the impact of Medicare Advantage and Part D.

This program will bring together perspectives from policy, practice management, and the pharmaceutical industry to explore how Medicare Advantage and Part D are influencing access to care, specialty medication availability, and the sustainability of private practices. Moderated by CSRO President Dr. Aaron W. Broadwell, our expert panel features:

• Meredith Hirsh – The Hirsh Center, CEO and Vice President
• James E. Mathews, PhD – Health Policy Alternatives, Principal
• Mike Ybarra, MD – PhRMA, Senior Vice President and Chief Medical Officer

Advocacy Conference: Join Us in September!

Advocating for patient access to care has been the cornerstone of CSRO's mission for more than two decades, and you're invited to join us this September 12-13 for our flagship Advocacy Conference in Dallas, Texas!

Attendees will gather with fellow advocates and members of the rheumatology community to learn, network, and strategize about advocacy. Our curated program will feature sessions highlighting current issues impacting patients and practices like the future of Medicare Advantage, biosimilars, PBM negotiations, and more.

Don't miss out! Registration is complimentary and open to anyone currently working within or retired from the field of rheumatology – visit our website to sign up now.

Legislation Around the Country

Recent Successes: Governors Sign CSRO Priorities into Law

With 12 state legislatures adjourned sine die, and the majority of states over halfway through their 2025 session, several of CSRO’s priority policies have been enacted across the country.

In Arkansas, Governor Sanders signed into law a prior authorization bill that empowers the insurance commissioner to impose fines when the utilization review entity or health plan are in violation and ensures prior authorization approvals remain valid for the entire course of the patient’s treatment. The Arkansas Rheumatology Association joined CSRO in submitting comments to Governor Sanders urging her to sign the legislation into law. CSRO also sent a grassroots alert to the CSRO community in Arkansas urging the Governor to sign the bill. HB 1300 was signed into law on April 10, 2025.

In Arizona, the state Medicaid office updated their biomarker testing coverage regulations after strong push back by patients and providers during their December comment period. CSRO joined the American Cancer Society Cancer Action Network (ACS CAN) in submitting comments urging the Agency to uphold the law as enacted, which extended biomarker testing coverage for all diagnoses, not just cancer.  In April, the Agency posted new regulations for public comment, which make significant improvements to uphold the intent of the law. 

CSRO has also engaged state legislatures and Governors to express concerns regarding the unfettered growth of the 340B drug discount program. These bills would enable greater expansion of contract pharmacies within the 340B program, without any oversight to ensure that underserved patients actually receive discounted medications from the contract pharmacies associated with disproportionate share hospitals. They would also make rheumatology practices more susceptible to acquisitions by large 340B hospitals, which are responsible for approximately 80% of hospital acquisitions. CSRO is disappointed that Governors in Nebraska, New Mexico, North Dakota, and South Dakota have ignored our concerns and signed these bills into law.

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.

Interested in learning more about CSRO’s engagement in the states? Visit our State Legislation Correspondence page to review the letters submitted to state legislatures on CSRO’s priority issues.

AK

• Prior Authorization | Step Therapy (HB144): Public Testimony

AL

• Prior Authorization (HB557): Pending Committee Action in House of Origin: Insurance

AR

• PBM Reform (HB1354): Adjourned Sine Die 04/16
• Prior Authorization (HB1300): Signed by Governor (04/09/2025)

CA

• Gold Card (SB306): From committee with author's amendments. Read second time and amended. Re-referred to Committee on Health .
• PBM Reform (SB41): Set for hearing April 29 in Judiciary pending receipt.
• Prior Authorization (AB512): From committee chair, with author's amendments: Amend, and re-refer to Committee on Health . Read second time and amended.
• Prior Authorization (AB510): From committee chair, with author's amendments: Amend, and re-refer to Committee on Health . Read second time and amended.

DE

• Prior Authorization (SB6): Introduced and Assigned to Banking, Business, Insurance & Technology Committee in Senate

FL

• Biomarker Testing Coverage (HB1335): Now in Health & Human Services Committee

GA

• Prescription Drug Affordability Board (HB931): Adjourned Sine Die 04/04

HI

• 340B Drug Pricing Program (HB712): Received notice of Senate conferees (Sen. Com. No. 788).
• Biomarker Testing Coverage (HCR35): Referred to Senate Committee on Health and Human Services, Senate Committee on Ways and Means.

IA

• Copay Accumulator Adjustment Program Ban | Rebate Pass Through | PBM Reform (HF852): Fiscal note.
• Rebate Pass Through | PBM Reform (SF383): Amendment S-3104 filed. S.J. 819.

IL

• 340B Drug Pricing Program (HB3350): Added Co-Sponsor Rep. Nabeela Syed
• 340B Drug Pricing Program (SB2385): Rule 2-10 Committee/3rd Reading Deadline Established As May 9, 2025
• Prescription Drug Affordability Board (SB66): Added as Co-Sponsor Sen. Kimberly A. Lightford
• Prior Authorization (HB3782): Rule 19(a) / Re-referred to Rules Committee
• Prior Authorization (SB2152): Rule 3-9(a) / Re-referred to Assignments
• White Bagging (SB1746): Rule 3-9(a) / Re-referred to Assignments

IN

• PBM Reform (SB140): House advisors appointed: Lehman, Carbaugh, Barrett, Dant Chesser and Shackleford
• PBM Reform (SB3): Signed by the President of the Senate

LA

• Delinking | PBM Reform (SB194): Introduced in the Senate; read by title. Rules suspended. Read second time and referred to the Committee on Insurance.
• PBM Reform (HB173): Reported with amendments (13-0).
• Rebate Pass Through | PBM Reform (HB264): Read by title, under the rules, referred to the Committee on Insurance.

MA

• 340B Drug Pricing Program (HB785): Senate concurred
• Rebate Pass Through | PBM Reform (HB1364): Senate concurred

MD

• Biomarker Testing Coverage (HB1301): Sent to the Governor
• Biomarker Testing Coverage (HB1086): Sent to the Governor
• Copay Accumulator Adjustment Program Ban (HB1246): Third Reading Passed (47-0)
• Copay Accumulator Adjustment Program Ban | Alternative Funding Program Ban | Maximizer Program Ban (SB773): Sent to the Governor
• Prescription Drug Affordability Board (HB424): Sent to the Governor

MN

• Copay Accumulator Adjustment Program Ban (HF1808): Author added Jones
• Prior Authorization (SF3306): Author added Boldon

MO

• Copay Accumulator Adjustment Program Ban (SB45): Informal Calendar S Bills for Perfection
• Copay Accumulator Adjustment Program Ban (HB982): Voted Do Pass (H)
• Prior Authorization | Gold Card (SB230): Informal Calendar S Bills for Perfection

MT

• Prior Authorization (SB447): Returned to Senate with Amendments

NC

• Non-Medical Switching (H434): Re-ref Com On Rules, Calendar, and Operations of the House
• Rebate Pass Through | PBM Reform (H163): Placed On Cal For 04/29/2025

ND

• 340B Drug Pricing Program (HB1473): Filed with Secretary Of State 04/03
• Copay Accumulator Adjustment Program Ban (HB1216): Reported back amended, do pass, amendment placed on calendar

NE

• 340B Drug Pricing Program (LB168): Approved by Governor on April 9, 2025

NM

• 340B Drug Pricing Program (HB78): Signed by Governor (04/07/2025)
• Prior Authorization (SB39): Signed by Governor (04/06/2025)

NV

• Biomarker Testing Coverage (AB382): (Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.)
• Maximum Fair Price limit (AB259): From committee: Amend, and do pass as amended.
• Prior Authorization (AB295): (Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.)
• Prior Authorization (AB463): Notice of eligibility for exemption.
• Prior Authorization | Step Therapy | PBM Reform | Biomarker Testing Coverage (AB74): (Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.)

OH

• Biomarker Testing Coverage (HB8): House Health: 2nd Hearing

OK

• 340B Drug Pricing Program (HB2048): Referred to Appropriations
• Prior Authorization | Step Therapy (HB1808): Referred to Appropriations

OR

• 340B Drug Pricing Program (HB2385): Referred to Health Care.
• 340B Drug Pricing Program (SB533): Work Session held.
• Prescription Drug Affordability Board (SB289): Public Hearing scheduled.

RI

• 340B Drug Pricing Program (H5634): Committee recommended measure be held for further study

Business of Rheumatology: May 14, 2025

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

Advocacy Conference: September 12-13, 2025

Register now to join us in Dallas, Texas, for CSRO's annual Advocacy Conference! 

Virtual Advocacy Day: October 8, 2025

Save the date to advocate alongside CSRO as we host live conversations with health care leaders. Be notified when registration launches by clicking here!

Fellows Conference: March 6-7, 2026

Calling all rheumatology fellows! Mark your calendars to join us in New Orleans, Louisiana, for CSRO's annual Fellows 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.

Explanatory Statement: “Underwater” Biosimilars

To aid in addressing the issue of "underwater" biosimilars with payers, CSRO has created a document to illustrate the extent of the problem.

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 Medscape.

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.