Greetings, Advocates! Great news for the rheumatology community came on Feb. 9, when the Bipartisan Budget Act of 2018 was enacted. It contains several critical healthcare fixes pertinent to rheumatology. First, after hundreds of emails, meetings, letters to the editor, an op-ed, and a forceful 109-member coalition (led by the ACR and including many state…
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The New Tax Bill’s Implications for Healthcare
On Dec. 20, 2017, Congress passed a massive tax bill that will have an impact on nearly every individual and business in America. The bill makes sweeping revisions to existing tax provisions, and it will largely affect the health industry. Individual Mandate Repealed The bill repeals the individual mandate established in 2005 by the Affordable…
Health Plans Enact Coverage Policies for Remicade & Infliximab Biosimilars
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
How to Avoid Insurance Denials for Prescribing a Biologic Without MTX in Concert
The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
U.S. Healthcare Spending to Climb 5.3 Percent in 2018
WASHINGTON (Reuters)—United States health spending is projected to rise 5.3% in 2018, reflecting rising prices of medical goods and services and higher Medicaid costs, a U.S. government health agency said on Wednesday, an upward trend it forecasts for the next decade. The increase represents a sharp uptick from 2017 spending, which the U.S. Centers for…
U.S. Telehealth Industry Eyes Medicare for Its Next Big Check
(Reuters)—After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions. Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the U.S.s’ huge over-65 health…
Amazon, Berkshire, JPMorgan Partner to Cut U.S. Healthcare Costs
NEW YORK (Reuters)—Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co. said on Tuesday they will form a company to cut health costs for hundreds of thousands of their employees, setting up a major challenge to an inefficient U.S. healthcare system. The move by three of the best-known U.S. business leaders—Amazon’s Jeff Bezos, Berkshire’s…
Health Secretary Nominee Indicates Support for Medicaid Overhaul
WASHINGTON (Reuters)—Alex Azar, a former drug industry executive and lobbyist nominated to run the U.S. Department of Health and Human Services, indicated on Tuesday he supported a Republican bid to overhaul Medicaid and again vowed to tackle high drug prices. Azar appeared before the Senate Finance Committee on Tuesday, which will ultimately decide whether to…
U.S. Official Says 8.8 Million People Signed Up for 2018 Obamacare Health Plans
NEW YORK (Reuters)—About 8.8 million people signed up for 2018 Obamacare health insurance plans on the federally run HealthCare.gov, a top U.S. health official said on Thursday, about a 4 percent decline from sign-ups for 2017. The Twitter post from Seema Verma, the head of the Centers for Medicare and Medicaid Services, did not provide…
With No Deal on Children’s Health Plan, U.S. States Scramble for Plan B
NEW YORK/WASHINGTON (Reuters)—For Nancy Minoui of Portland, Oregon, and Crystal Lett of Dublin, Ohio, Congress’ failure to fund the Children’s Health Insurance Program is not some distant tale of political wrangling. For Minoui, it’s about how to provide care for her daughter, Marion Burgess, born last Valentine’s Day with a hole in her heart. For…
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