Over the last several months, the ACR has met with commercial payers and the Centers for Medicare & Medicaid Services to provide feedback on formulary requirements that would leave practices under water when treating patients with the biosimilars infliximab-axxq (Avsola) or infliximab-dyyb (Inflectra). Specifically, the ACR has raised concerns about payers mandating use of these specific biosimilars, despite reimbursement falling below acquisition cost for many independently owned rheumatology practices.
In response to the concerns shared by the ACR and other stakeholders, UnitedHealthcare (UHC) has updated its reference pricing for these drugs effective April 1, 2024, with the intention of ensuring that rheumatology practices remain solvent and are able to continue infusing the drugs in office. UHC will continue to monitor this issue to determine whether further adjustments are needed.
For additional information or to request the ACR’s help with other payer issues impacting your practice, reach out to [email protected].
