On Capitol Hill

GOP Doctors Caucus Engages CSRO on Physician Reimbursement Challenges

Recently, CSRO participated in two key meetings convened by staff of the GOP Doctors Caucus leadership to address physician reimbursement challenges. Established in 2009, the Caucus provides a forum for Republican members of the House and Senate with medical and health care provider backgrounds to collaborate on health policy solutions.

On September 23, a representative on behalf of CSRO attended a meeting hosted by the Caucus with other physician advocacy groups to discuss the House Committees on Energy and Commerce and Ways Committee efforts on next steps on Medicare payment reform. The meeting included discussion on new draft proposals to fix the conversion factor, in line with recent MedPAC recommendations and efforts to advance previously considered legislation in committee to adjust the budget neutrality threshold.

On October 1, CSRO, in its role as co-lead of the Underwater Biosimilars Coalition, attended a meeting with Caucus staff to underscore the challenges posed by underwater biosimilars, where reimbursements below acquisition cost jeopardize both rheumatology practices and patient access. CSRO also discussed options for addressing step therapy through regulatory clarification and reforms that would help patients access another therapy, when necessary. CSRO looks forward to continuing its collaboration with the GOP Doctors Caucus and Congress to advance sustainable policy solutions that safeguard practices and the patients they serve.

White House and Pfizer Reach First MFN Agreement

Earlier this week, the White House and pharmaceutical manufacturer Pfizer announced the first most favored nation (MFN) agreement. The announcement follows President Trump’s July Executive Order instructing pharmaceutical companies to “bring down the prices of prescription drugs in the United States to match the lowest price offered in other developed nations (known as the most-favored-nation, or MFN, price)”, which had a September 29 deadline. Several CSRO Board members expressed concerns about the MFN model’s impact to the ASP add-on payment in opinion editorials, including Amar Majjhoo, MD, FACR (Detroit News) and Amish Dave, MD, MPH (The Spokesman-Review).

Under the October agreement, Pfizer will extend MFN pricing to state Medicaid programs and make select medicines—including the arthritis drug Xeljanz—available at discounted rates through the Administration’s new direct-to-consumer platform, TrumpRx. In return, Pfizer secured a three-year exemption from potential pharmaceutical tariffs and committed to $70 billion in US manufacturing capacity. The Trump Administration has confirmed that they are in similar negotiations with additional manufacturers. Due to these negotiations, the Administration has paused its previously announced tariffs on the pharmaceutical industry. CSRO previously expressed concerns to the Secretary of Commerce regarding these proposed tariffs and the impact of tariffs on the ASP add-on payment.

Legislation Around the Country

CSRO and the Michigan Rheumatism Society Raise Concerns on 340B Contract Pharmacy Expansion 

Last month, CSRO and the Michigan Rheumatism Society (MRS) submitted joint comments to the Michigan House Committee on Health Policy articulating concerns with H.B. 4878, legislation addressing the federal 340B drug program. CSRO and MRS raised concerns with provisions that would expand the use of contract pharmacies without any additional oversight and transparency measures to ensure underserved patients actually benefit from the discounted medications. The joint letter underscored how the 340B program has strayed from its original mission of supporting vulnerable patients, warning that this legislation would further accelerate healthcare consolidation and undermine physician practices—ultimately failing patients.

CSRO Supports Massachusetts Bill Banning White Bagging Practices 

CSRO submitted comments in support of H.1313, legislation that seeks to ban white bagging practices by pharmacy benefit managers (PBMs) and health benefit carriers in Massachusetts. In these comments, the Coalition highlighted how white bagging policies increase costs for patients and self-funded plans, serving primarily to boost PBM profits. Additionally, CSRO expressed concerns about the integrity and safety of drugs that are white bagged and prepared outside of rheumatology offices, noting that this could pose serious safety risks for patients. CSRO’s comments were submitted before the Massachusetts Joint Committee on Financial Services hearing on the bill, scheduled for October 1, and the bill awaits further consideration by the Legislature.

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients. Check out the list below to see the status of CSRO priority bills from the past two weeks, and click here to view a full status report of CSRO priority bills.

Interested in learning more about CSRO’s engagement in the states? Visit our State Legislation Correspondence page to review the letters submitted to state legislatures on CSRO’s priority issues.

MA

• 340B Drug Pricing Program (HB1107): Accompanied a new draft, see H4490
• 340B Drug Pricing Program (HB1296): Accompanied a new draft, see H4495
• 340B Drug Pricing Program (HB785): Reported favorably by committee and referred to the committee on Health Care Financing
• 340B Drug Pricing Program (HB4490): Reported favorably by committee and referred to the committee on Health Care Financing
• Copay Accumulator Adjustment Program Ban | Rebate Pass Through | PBM Reform | Maximizer Program Ban (HB1234): Bill reported favorably by committee and referred to the committee on House Ways and Means
• Delinking | PBM Reform (HB1082): Reported favorably by committee and referred to the committee on Health Care Financing
• Prior Authorization (SB1403): Bill reported favorably by committee and referred to the committee on Senate Ways and Means
• Rebate Pass Through | PBM Reform (HB1364): Bill reported favorably by committee and referred to the committee on House Ways and Means
• White Bagging (HB1313): Hearing rescheduled to 10/01/2025 from 10:30 AM-01:00 PM in B-1 and Virtual Hearing location changed

OH

• Non-Medical Switching (SB160): Senate Financial Institutions, Insurance and Technology: 2nd Hearing
• Rebate Pass Through | PBM Reform (HB448): Refer to Committee: Insurance

WI

• Prior Authorization (AB432): Fiscal estimate received



Virtual Advocacy Day: October 8, 2025

Join us next week to advocate alongside CSRO as we host live conversations with health care leaders. Registration is now open! Register here!

Fellows Conference: March 6-7, 2026

Calling all rheumatology fellows! Mark your calendars to join us in New Orleans, Louisiana, for CSRO's annual Fellows Conference.

State Society Conferences:

CSRO's state rheumatology society members host their own annual meetings throughout the year. Find a listing of these state-specific conferences on our website.

ACR Member Breakfast:

Join CSRO during the ACR Conference 2025 in Chicago, IL for an Exclusive Member Breakfast on Sunday, October 26th. Sign up here!

Action Center

Use CSRO's convenient online platform to easily find out who your elected officials are and engage with them directly.

Advocacy Council

Amplify your voice by assembling with other like-minded individuals to enhance CSRO’s advocacy initiatives.

Career Center

Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.

Explanatory Statement: “Underwater” Biosimilars

To aid in addressing the issue of "underwater" biosimilars with payers, CSRO has created a document to illustrate the extent of the problem.

Legislative Map Tool

Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.

Payer Issues Reporting Form

Request assistance with any payer relation issues that may be impacting your patients or office.

Policy Correspondence

Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.

Rheum for Action

Learn about the latest advocacy issues in CSRO's advocacy column authored by Dr. Madelaine Feldman and produced in partnership with Medscape.

Step Therapy Cover Sheets

Review CSRO's state-specific step therapy materials that help guide practices in gaining an exemption from step therapy protocols.

Questions?

Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at info@csro.info.