On Capitol Hill

CSRO Celebrates PBM Reform Win in Federal Appropriations Package

On Tuesday, President Trump signed H.R. 7148, the Consolidated Appropriations Act of 2026, into law—a $1.2 trillion funding package that includes landmark reforms for pharmacy benefit managers (PBMs). The passage of the PBM provisions marks a significant victory for CSRO, which has long been a leading voice among providers calling on Congress to increase PBM accountability and transparency. CSRO was pleased to see four key reforms included in the bill: delinking in Medicare Part D; 100% commercial rebate pass-throughs to employers; expanded transparency requirements in Medicare and Part D; and a ban on Medicaid spread pricing. While the Coalition is grateful for the rebate pass-through provisions in the federal spending package, CSRO will continue to educate policymakers and advocate for rebate reforms that directly benefit patients at the point of sale, as well as other policies to rein in their abusive practices.

CSRO Submits CY 2027 MAPD Comments, Cosigns ASM Letter

Last week, CSRO submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the CY 2027 Medicare Advantage and Part D proposed rule, reiterating longstanding concerns about beneficiary access to provider-administered biosimilars. In their letter, CSRO highlighted that “over-rebating” has drastically reduced Average Sales Prices (ASPs) for certain biosimilars, leaving many therapies reimbursed below acquisition cost and disrupting access to care for Medicare Advantage (MA) enrollees when coupled with step-therapy requirements for these drugs. To address this challenge, CSRO urged CMS to establish a “formulary adequacy standard” requiring MA plans to ensure that any provider-administered drug placed in a fail-first or step-therapy position is reasonably available to the enrollee’s treating provider, and to permit access to a clinically appropriate alternative when acquisition-cost constraints prevent furnishing the plan-mandated therapy.

In addition, CSRO cosigned the Alliance of Specialty Medicine’s CY 2027 MAPD comment letter, which addressed broader systemic concerns affecting specialty physicians and beneficiaries, including network adequacy failures, provider terminations, the administrative burden associated with risk-adjustment medical record requests, and proposed changes to Star Ratings measures. CSRO contributed extensive, specialty-specific detail on network adequacy challenges in rheumatology, underscoring the real-world access barriers faced by MA enrollees. Read more in the CSRO and Alliance comments.

CMS Announces Drug Negotiation for Part B

On January 27, CMS announced its selection of drugs for the third cycle of the Medicare Drug Price Negotiation Program (MDPNP), which for the first time includes negotiated Part B drugs. Part B selected drugs include: Botox; Botox Cosmetic; Cimzia; Cosentyx; Entyvio; Erleada; Orencia; and Xolair. CMS also announced additional Part D drugs, building upon the 2026 and 2027 MDPNP selections. CSRO has been highly engaged with CMS on their 2028 Part B drug selection, including comments in June 2025 on Medicare Drug Price Negotiation Program Draft Guidance for IPAY 2028. CSRO plans to participate this Spring when CMS hosts listening sessions on the drug selection before setting a price on these drugs.

Legislation Around the Country

VA: CSRO Opposes Legislation to Establish a Prescription Drug Affordability Board

Last week, CSRO submitted comments to the Virginia House Committee on Labor and Commerce opposing HB 483, which would establish a Prescription Drug Affordability Board (PDAB) and impose upper payment limits (UPLs) on select prescription drugs. CSRO board member, Harry Gewanter, MD, FACR, also testified in person last week before the Senate and has been a leading voice on the ground against creating a PDAB in Virginia. CSRO raised concerns that the legislation would establish UPLs for certain provider-administered medications at Medicare’s maximum fair price, potentially limiting patient access and placing significant financial strain on rheumatology practices. CSRO also warned that the proposal could incentivize PBMs to manipulate formularies by making UPL drugs less accessible (higher tier) than higher-priced drugs that would generate greater profits for the PBM. Finally, CSRO urged lawmakers to amend the bill to ensure that only true therapeutic equivalents—not alternatives—are considered appropriate for substitution, thereby best serving patients and their disease management.

KS: CSRO and PPPC Support Rebate Pass Through Legislation 

Ahead of last week’s hearing in the Kansas Senate Committee on Financial Institutions and Insurance, CSRO submitted a letter of support for SB 360 and co-signed a letter with the Patient Pocket Protector Coalition (PPPC). CSRO supports SB 360 because it would require 100% of drug manufacturers’ rebates to bypass PBMs and flow directly to patients, delivering immediate savings at the pharmacy counter. Similar policies have already been enacted in West Virginia, Indiana, and Arkansas, providing meaningful cost relief for patients without increasing premiums. CSRO will continue partnering with PPPC to encourage Kansas lawmakers to advance this bill.

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.

CSRO State Legislative Forecast: February 11, 2026

Kick off the year with CSRO’s virtual State Policy Update, highlighting key priorities and trends for the 2026 legislative session. Hear from our government affairs team about upcoming policies affecting private practice, reimbursement, and patient access—and how you can advocate effectively. 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.

Advocacy Conference: October 2-3, 2026

Join us in Washington, D.C. for CSRO’s flagship Advocacy Conference to learn, network, and strategize around patient access to care. Sign up for the Registration Launch here!

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.

Action Center

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

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.