The Insurance Subcommittee is working to address coverage and reimbursement challenges facing rheumatology practices. Recent activities include efforts to avoid increased administrative burden associated with specialty medications, support payer coverage of musculoskeletal ultrasounds and protect patient access to biologics.
The ACR is advocating against policies that threaten patient access and disrupt practice workflow, including non-medical switching, tapering patients off biologics, specialty pharmacy acquisition mandates and site-of-service restrictions.
The ACR recently had an opportunity to speak with Anthem leadership to follow up on concerns about specialty pharmacy acquisition mandates being implemented by Anthem plans in California and New York. Anthem clarified that they do not expect these mandates to impact community-based providers. Beginning in December 2020, Anthem plans in certain states will require…
Despite efforts by the ACR and other organizations, Blue Cross Blue Shield of Tennessee has indicated that it will move forward with implementation of its specialty pharmacy acquisition mandate on July 1, 2020.
In partnership with rheumatology and other specialty organizations, the ACR is working against payer and employer policies that mandate specialty pharmacy acquisition of in-office treatments.
The ACR Insurance Subcommittee is working to address specialty pharmacy requirements for in-office treatments, elimination of consultation codes and other coverage and reimbursement challenges.