As insurers phase out pandemic-related flexibilities, many are raising new obstacles to try to limit their financial exposure.
Improving Seniors’ Timely Access to Care Act Reintroduced in House
The Improving Seniors’ Timely Access to Care Act (H.R. 3173) will require the Centers for Medicare & Medicaid Services to regulate the use of prior authorization by Medicare Advantage plans and establish a process to make real-time decisions for services that are routinely approved. Ask your Congressperson today to support providers and patients and join the more than 100 representatives who are co-sponsoring the bill.
Spring Review of 2021 State Legislative Progress
Bright spots from this legislative session include utilization management reform, copay accumulator bans and pharmacy benefit manager reform.
Advantages of Embedding a Specialty Pharmacist in a Rheumatology Clinic
The number of medications with rheumatologic indications has increased in parallel with expanding complexities of medication approval and delivery. Simply starting a patient on a biologic medication or new disease-modifying anti-rheumatic drug (DMARD) can be time consuming and frustrating for physicians, nurses and their support staff. In addition to educating the patient and obtaining prior…
UHC Updates Rituximab Policy to Require Use of Biosimilars
As of Oct. 1, UnitedHealthcare (UHC) requires that patients fail to respond to both FDA-approved rituximab biosimilars prior to receiving approval for rituximab. Exception: Rituximab-pvvr (Ruxience) is not FDA approved for rheumatoid arthritis.
Ethics Forum: The Ethical Considerations of Prior Authorization
The mother of a 15-year-old patient with juvenile idiopathic arthritis/enthesitis-related arthritis (JIA/ERA) called the office in tears. She said she was having an insurance problem. Her son had been a star track athlete when he developed severe back pain. Magnetic resonance imaging showed evidence of severe sacroiliitis. He was started on a tumor necrosis factor…
UnitedHealthCare Rescinds Planned Changes to Orencia Policy
UnitedHealthcare (UHC) is rescinding changes to its Orencia policy previously scheduled to go into effect July 1, 2020. These changes would have required patients to fail to respond to the self-administered formulation of the drug prior to obtaining authorization for the physician-administered product. Some patients on Orencia received notices from UHC in late April stating…
UnitedHealthcare to Implement Fail-First Requirement for Self-Administered Orencia
On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product. The ACR has been in communication with UHC about this policy since October 2019, when the payer…
ACR Urges Commercial Payers to Provide Relief from Prior Authorizations, Practice Disruptions
The ACR is urging insurance companies to expand access to telehealth services and provide relief from administrative burdens to help providers focus on patient care at this critical time.
Copay Accumulator Programs Can Derail Rheumatologic Treatment Plans
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…