Three commercial health insurance payers have increased reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
UnitedHealthcare Updates Reimbursement for Infliximab Biosimilars
On April 1, UnitedHealthcare updated reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
Change Healthcare/Optum Cyberattack: Key Updates on Claims Disruptions & Emergency Funding
The Feb. 21 cyberattack on Change Healthcare, the clearinghouse vendor that connects providers with insurance payers, including Medicare, has caused unprecedented challenges and had a critical financial impact on payments to providers nationwide. UnitedHealthcare Group (UHG), the parent company of Change, confirmed on March 8 that it is making significant progress to restore all systems….
Updates from the ACR Insurance Subcommittee
The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices, including issues related to biosimilar use, in-office treatments and the new G2211 code.
The ACR Advocates for G2211 Reimbursement under Medicare Advantage & Commercial Plans
The ACR is reaching out to Medicare Advantage and commercial payers to ensure appropriate reimbursement for the new complex care add-on code, G2211, implemented for outpatient office visits starting Jan. 1, 2024.
The Biosimilar Economic Conundrum: Where We Stand
Reimbursement has fallen below acquisition price for some biosimilar versions of infliximab, forcing practices and patients to make difficult decisions. The ACR is working to change this.
Blue Cross NC Revises Autoimmune Pathways Program
After meeting with the ACR and other stakeholders, Blue Cross NC and OMI announced revisions to their Autoimmune Pathways Program to drop biologic tapering requirements and paying providers according to specific treatment decisions.
ACR Insurance Subcommittee Tackles Known Issues
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.
A Unique Partnership Gives the ACR a Voice in Insurance Legislation Development
A recent meeting of the National Council of Insurance Legislators (NCOIL) featured discussions of many topics important to ACR members, including pharmacy benefit manager legislation, biomarker testing and transparency in the healthcare market.
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
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