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 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.
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.
At my first Advocacy Leadership Conference as a member of the ACR’s Insurance Subcommittee, I discovered the power of stories from the clinic and how lawmakers value clinicians’ input on healthcare legislation.
The ISC has worked with CVS Caremark to revisit changes to its prior authorization forms that would have increased the administrative burden on practices, and patients with Blue Cross Blue Shield of South Carolina may not have to worry about switching to a self-administered biologic.
Rheumatology practices have a voice in payer advocacy through the Insurance Subcommittee of the ACR’s Committee on Rheumatologic Care.
Spurred by a recent Cigna policy, the ACR will lead a resolution to oppose insurance companies providing financial incentives for patients to switch treatments. Several specialties are cosponsoring the resolution for a special meeting of the AMA House of Delegates in June.
Volunteer leaders who are community rheumatologists share their thoughts about the professional and personal benefits of serving on ACR committees and encourage others to get involved.
The ACR has sent a letter to Cigna expressing opposition to the initiative, which jeopardizes patients’ health, interferes with medical decision making, undermines the doctor-patient relationship and may disproportionately affect patients of lower socioeconomic status.
In a letter sent to commercial payers, the ACR’s Insurance Subcommittee is advocating for continued coverage for telemedicine, including reimbursement parity, after the end of the declared public health emergency.