Following CSRO's advocacy, the Partnership for Quality Measurement (PQM) Pre-Rulemaking Measure Review (PRMR) announced that the committee reviewing clinician-level measures did not recommend a newly-developed cost measure for rheumatoid arthritis (RA) for use in the Merit-based Incentive Payment System (MIPS) program.

As previously reported, CSRO requested that the cost-measure not be recommended for use in the MIPS program last year. CSRO’s Co-Founder and Past President, Michael Schweitz, MD, served on the Technical Panel that developed the measure, consistently raising concerns about unintended consequences of the RA cost measure on practicing clinicians and their patients – read more in CSRO's letter to PQM.

CSRO will send in support for the PRMR committee’s recommendation, and continue to share updates as appropriate.

On February 5, the House Oversight and Accountability Committee voted to advance the DRUG Act (H.R.6283), a bill to delink drug pricing from pharmacy benefit manager (PBM) income. The Oversight Committee is one of the four House Committees with jurisdiction over this legislation, because that Committee has responsibility over the Federal Employee Health Benefits (FEHB) program, to which the bill’s provisions would apply.

Committee Chairman James Comer (R-KY-01) offered a substitute bill containing technical edits and providing the authority for any civil monetary penalties collected for violations to be deposited into the FEHB fund. Besides that, several amendments were offered and discussed, and two were adopted:

1. An amendment by Rep. Lynch (D-MA-08) would provide the Inspector General full access to PBMs’ contractual information. That was adopted after its scope was narrowed to fit within the Committee’s jurisdictional limits.
2. An amendment by Rep. Krishnamoorthi (D-IL-08) would provide additional strengthening of the bill’s transparency provisions.

Several Members on both sides of the aisle expressed concern about PBM reform: on the Democratic side, the general sentiment was that Congress was charging forward without sufficient underlying data, while some Republican Members were concerned that Congress overreaches when it interferes in the business practices of PBMs.

Both sides expressed concern that the potential for unintended consequences is high, particularly due to the incredible complexity of pharmaceutical pricing. Ultimately, however, twenty-nine Members voted to advance the bill, while eleven voted against it and one voted present.CSRO will continue to monitor and share updates as appropriate.

This year, the Iowa legislature is considering legislation to require coverage of biomarker tests that demonstrate clinical utility. As this technology sees expanded use in the rheumatology space, it is important to ensure these tools are accessible for rheumatologists to utilize in their practices.

The House version of the bill was originally limited to products only used by oncologists. This week, CSRO Board Member Dr. Michael Brooks (pictured left) spoke to the House subcommittee to help convince them to expand the legislation to cover all types of biomarkers regardless of targeted disease.

CSRO is pleased to report that these efforts were successful, and the bill will advance with amendments. 

Healthcare is a primary benefit offered to employees, often at great expense to employers. While just a part of the total equation, the pharmacy benefit can be a significant element of the overall outlay.

CSRO’s employer education program provides employers with insights into benefit administrator practices and the systems driving their behavior.

To support these efforts, CSRO's new webpage allows organizations and companies to request a presentation to learn more about these hidden realities – visit our website for details. 

Is your rheumatology clinic looking for the perfect candidate? Are you a rheumatologist, advanced practice provider, or practice manager looking for new career opportunities? CSRO's Career Center is a great tool for locating the perfect fit.

Devoted exclusively to the rheumatology community, employers are able to easily post positions on CSRO's Career Center for a minimal fee. Then, candidates looking for new opportunities within the rheumatology specialty can browse all of the postings for free.

Plus, if you're interested in marketing a position to fellows-in-training or early-career rheumatologists; we've got you covered! CSRO's Career Center will be shared with hundreds of potential candidates from around the nation as part of CSRO's Fellows Conference next month.

CSRO is recruiting for a Fellow-at-Large to serve as a non-voting member of our Board of Directors for a one-year term beginning May 1.

This position provides a unique experience for a rheumatology fellow to engage with CSRO's Board members, who are rheumatologists from across the United States with years of varied career experiences, and to be a liaison to other fellows as they learn more about the importance of advocacy in rheumatology. 

The application deadline is March 28. Interested or know someone who might be? Check out our website to learn more and apply.

CSRO Fellows Conference: March 1-3, 2024

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

CSRO Advocacy Conference: September 20-22, 2024

Mark your calendars to join us 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 conferences on our website.

What's Happening in the Capitol

Yesterday, February 8, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing entitled, “Why Does the United States Pay, by Far, the Highest Prices in the World for Prescription Drugs?” The hearing featured two panels, with the first consisting of the CEOs of Bristol Myers Squibb, Johnson & Johnson, and Merck, and the second of representatives from Public Citizen, the Initiative for Medicines, Access & Knowledge, and the University of California’s Schaeffer Center.

In his opening remarks, Chairman Sanders (I-VT) highlighted Stelara as an example of a product for which U.S.-based patients pay higher prices than patients living abroad, and stressed that pharmacy benefit managers have nothing to do with such discrepancies. For his part, Ranking Member Cassidy (R-LA) opened the hearing by referring to it as a “public verbal stoning” of CEOs and decrying the fact that the hearing was not intended to actually identify solutions. In his questioning, Senator Cassidy brought up the rebate walls that freeze out biosimilar competition, including initially with Inflectra, a biosimilar for Remicade.

Leading up to the hearing, CSRO did social media expressing appreciation for the continued congressional focus on drug pricing, but highlighting that no investigation of high drug prices is complete without the pharmacy benefit manager industry at the table.

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.

Alaska

Gold Card

• SB 219: Referred to Labor and Commerce committee

Arizona

Prescription Drug Affordability Board

• SB 1533: Referred to Senate Finance and Commerce committee

Prior Authorization & Non-medical Switching

• HB 2726: Assigned to Health and Human Services committee

California

Rebate Pass Through

• SB 966: Introduced

Colorado

Gold Card

• HB 1149: Introduced and assigned to Health and Human Services committee

Florida

Biomarker Testing

• SB 964: Approved by Banking and Insurance committee 

Hawaii

Biomarker Testing

• HB 2223: Approved by committee 
• SB 2551: Referred to committees

Illinois

Prescription Drug Affordability Board

• SB 3108: Referred to Assignments

White Bagging

• SB 3225: Referred to Assignments

Indiana

Biomarker Testing

• SB 273: Approved by the Senate

Iowa

Biomarker Testing

• SSB 3001: Committee approves bill, renumbered to SF 2159
• SF 2159: Committee report approving bill
• HB 2157: Subcommittee recommends amendment and passage 

Prescription Drug Affordability Board

• SF 2238: Introduced and assigned to subcommittee

Gold Card

• HSB 641: Subcommittee recommends passage

Kentucky

Prior Authorization - Gold Card

• HB 318: Referred to Banking and Insurance committee

Rebate Pass Through

• SB 149: Referred to Banking and Insurance committee

Massachusetts

Accumulators

• S.609: Reported favorably by Joint Financial Services committee
• H.953: Reported favorably by Joint Financial Services committee

Maryland

Prescription Drug Affordability Board

• SB 388: Hearing scheduled for 2/07
• HB 340: Referred Public hearing 2/08

Rebate Pass Through

• SB 1019: Hearing scheduled for 3/13

White Bagging

• SB 754: Hearing scheduled for 2/28

New Mexico

Step Therapy

• SB 135: Referred to Committees’ committee
• HB 185: Reported do pass

New York

Rebate Pass Through

• A1962: Amended and re-committed to Insurance committee

Oregon

White Bagging

• HB 4012: Public hearing held

Accumulators

• HB 4113: Public hearing held

Rhode Island

White Bagging

• S2086: Scheduled for consideration 2/8
• H7365: Introduced and referred to House Health and Human Services committee

Utilization Management Reform & PBM Regulation

• H7139: Committee recommends measure be held for further study

South Carolina

Accumulators

• HB 3618: Public hearing held

Accumulators and Maximizers

• SB 1024: Referred to committee on Banking and Insurance

Prescription Drug Affordability Board

• HB 4984: Referred to Labor, Commerce and Industry committee

Vermont

Prescription Drug Affordability Board

• S98: Referred to Committee on Health and Welfare

Virginia

Prescription Drug Affordability Board

• SB 274: Approved by committee, referred to Finance and Appropriations committee
• HB 570: Subcommittee recommends passage

Rebate Pass Through

• HB 1041: Subcommittee recommends laying over until 2025

Wisconsin

Accumulators, Non-medical Switching, & PBMs

• SB 737: Introduced and Senate hearing held
• AB 773: Committee hearing scheduled for 2/14

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 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.