If passed, the ACR-led resolutions will direct the AMA to advocate for state-level pharmacy benefit manager reform and to fix broken Medicare Administrator Contractor processes. Several other specialties joined the ACR’s resolutions as supporting cosponsors.
Amid rising drug costs and the growing influence of pharmacy benefit managers on patient care decisions, physicians are increasingly called upon to advocate for affordable, evidence-based treatments for their patients.
On Dec. 10, the Supreme Court of the United States of America (SCOTUS) issued a landmark decision in Rutledge, Attorney General of Arkansas, v. Pharmaceutical Care Management Association. In an 8–0 decision, the justices agreed that states have the right to impose regulations on pharmacy benefit managers (PBMs), companies that manage prescription drug benefits on…
(Reuters Health)—U.S. commercial health plans only covered biosimilar treatments as preferred products in 14% of coverage decisions last year, according to an analysis of publicly available data on coverage decisions.1 Researchers examined records from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database, which has information on coverage decisions made by 17 of…
She wanted me to call in an antibiotic. My sister, a lawyer, often tells me how the ethics of her profession govern even her extra-professional acts. She feels that when she was sworn into the New York State bar, she lost the freedom to bend the truth. She would never, for example, attempt to smuggle…
As the medications for rheumatology become more expensive, the need for patient financial assistance becomes paramount. Unfortunately, commercially insured patients are finding it difficult to afford the exorbitant copays required by their plans, and the latest strategy of pharmacy benefit managers (PBMs) threatens to derail rheumatologic treatment goals. High deductible plans combined with copay accumulator…
ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…
The cards sat, untouched, in a corner of my desk. In the 1800s, it was common for American saloons to provide patrons with a free meal. Of course, the meal came with a catch: The meals were predictably salt laden and designed to encourage patrons to drink more beer. Hence was born the expression, “There…
So far it has been a busy year for the Affiliate Society Council (ASC). Forty-three states are now affiliated with the ACR through the ASC, and we may add another next year. Also, many state legislative sessions have wrapped up, so it’s a great time to provide an overview of the successes—and some of the…
Greetings from Washington, D.C., where ACR leaders just held more than 100 meetings on Capitol Hill supporting reforms to step therapy and prior authorization, increased reimbursement for dual-energy X-ray absorptiometry (DXA), solutions to the rheumatology workforce shortage, and rheumatology-specific research at the Pentagon. We’re already hearing great news about our successes: Hours after our visit,…