Coalition Educates Congress on Underwater Biosimilars

In a letter to congressional leadership, the Underwater Biosimilars Coalition – which CSRO co-chairs – educated members of Congress about the underwater reimbursement of biosimilar products. Congress has been focused on ways to improve biosimilar access, through legislation like the Biosimilar Red Tape Elimination Act (S.2305). 

The Coalition warned that while the legislation aims to improve access to biosimilars, the bill fails to recognize an immediate serious barrier to patient access to provider-administered biosimilars – “underwater” provider reimbursement. Without addressing this inadequate, or “underwater” reimbursement, patients will continue to lose access to needed biosimilars and their reference product (i.e., brand biologics), and biosimilar adoption will continue to hit roadblocks. This situation may only worsen as more provider-administered biosimilars come to market.

CSRO Supports Coalition Efforts to Advance Federal PBM Reform

In addition to CSRO’s efforts to advance PBM reform, we have also supported other coalition voices calling for congressional action. The Partnership to Fight Chronic Disease coordinated a letter to congressional leadership urging them to include the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (S. 3430) and the Modernizing and Ensuring PBM Accountability (MEPA) Act (S. 2973) in a year-end package. Both bills passed the Senate Finance Committee on a bipartisan basis and offer meaningful reforms for Medicare beneficiaries, including lowering their costs for medicines and increasing transparency and accountability for pharmacy benefit managers.

Visit the CSRO Action Center to contact your members of Congress today and encourage them to address PBM reform before the end of the 118^th Congress.

In a new The Virginia Mercury opinion piece, CSRO Board Member Dr. Harry Gewanter highlights how the 340B program has shifted away from its original purpose, and urges Congress to take action on the matter, explaining that "while 340B is an important safety net in Virginia, it is in dire need of federal action to improve transparency and accountability measures to ensure it works as intended."

Help Make a Difference: Donate Today

Advocacy can have a tremendous impact on a patient's access to care, disease management options, and overall quality of life, and it has been the cornerstone of CSRO's mission since we were founded in 2003.

One father has experienced that impact firsthand as he witnessed CSRO successfully advocate for his son's access to effective treatment for juvenile arthritis. He donated to CSRO to help ensure others will benefit from our commitment to achieving the highest quality of care for all patients, nationwide.

Help make a difference by supporting advocacy for critical rheumatological care and make a tax-deductible donation today – give now!

CO: PDAB Establishes UPL on Enbrel

The Colorado Prescription Drug Affordability Board (PDAB) recently announced that it will proceed with rulemaking to establish an upper payment limit (UPL) for Enbrel. The rulemaking process will include three hearings in January, February, and March, during which public comments and invited expert testimony will be considered.

Following the rulemaking, the Board will establish an upper payment limit. CSRO has repeatedly voiced concerns to the Colorado PDAB over the upper payment limit as it caps provider reimbursement for select prescription drugs at a rate determined by the Board. It does not, however, require that providers acquire the medication at a rate sufficiently below the UPL to account for acquisition costs to the provider. This is highly problematic for healthcare providers who buy-and-bill.

MI: CSRO Expresses Concerns over 340B Program

In a letter to the Michigan Senate Oversight Committee, CSRO and the Michigan Rheumatim Society shared concerns regarding S.1179, which would allow for significant growth in the 340B drug discount program and fails to incorporate guardrails that ensure patient access to discounted medications. This fall, CSRO released its explanatory statement and policy principles on the 340B program, offering recommendations on ways to strengthen the program and better protect patient access. Unfortunately, the bill was released from Committee and now awaits consideration on the Senate floor. 

NJ: CSRO Supports Biomarkers Coverage and Accumulator Ban

On December 12, CSRO submitted comments in support of legislation that would ban accumulator adjustment programs (S.3818) and legislation that would mandate coverage for biomarker testing (S.3098), respectively. 14 states currently require biomarker testing coverage for all state-regulated health plans. By incorporating biomarker testing into medical practice, rheumatologists can identify effective therapies more quickly, leading to timely and personalized patient care.

21 states have enacted laws that require health insurance plans to count copay assistance paid by or on behalf of a patient toward their annual deductibles and out-of-pocket limit. S.3818 would prevent insurers from discriminatorily punishing patients with complex chronic conditions through the use of accumulator programs.

The New Jersey Senate Commerce Committee heard and voted both bills out of committee favorably. 

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.

New Jersey

Accumulators

• S.3818: Heard in Senate Commerce Committee

Biomarker Testing

• S.3098: Heard in Senate Commerce Committee

Business of Rheumatology: January 29, 2024

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

CSRO Fellows Conference: February 21-23, 2025

An annual event to help rheumatology fellows prepare for their future roles as practicing rheumatologists.

CSRO Advocacy Conference: September 12-14, 2025

Mark your calendars to join us in Dallas, Texas, 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.

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 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.