Specialty Pharmacy & Home Infusion Mandates
The ACR continues to see select health plans introducing policies that would require specialty pharmacy acquisition of in-office treatments. These policies prohibit the traditional buy-and-bill method of obtaining drugs, limiting practices’ ability to continue providing these critical therapies. Most recently, the ISC sent a letter to Blue Cross Blue Shield of Massachusetts about a new policy that only permits specialty pharmacy acquisition or home infusion for certain biologics. The ISC will continue to advocate against this misguided policy and against all policies that would limit patients’ access to receiving provider-administered treatments in their rheumatologists’ office.
Working for Members
In addition to the issues outlined above, the ISC has received numerous health plan complaints that occurred with the start of the new year. These include changes in step therapy criteria, formulary adjustments, prior authorization issues and payer coding and reimbursement errors. These issues continue to disrupt patient care and add to the workload of rheumatology practices. As complaints are received, the ISC continues to investigate and reach out to the health plans to help ensure resolution.
The ISC is available to help members with issues related to insurance policies and payers. For more information about the issues above or to request ACR’s help on other payer issues impacting your practice, reach out to [email protected].
