On Capitol Hill

CSRO Urges the White House to Rein in Abusive Cost-Shifting Practices by PBMs and AFPs

On May 5, CSRO, along with members of the Alternative Funding Program Task Force, sent a letter to the White House Domestic Policy Council. The letter called on the Administration to take action against harmful cost-shifting practices employed by pharmacy benefit managers (PBMs), insurers, and other for-profit middlemen. Specifically, the letter highlighted that tactics like copay accumulator adjustment programs, the inclusion of non-essential health benefits, and alternative funding programs (AFPs) are increasing patient costs, limiting access to care, and imposing significant administrative burdens on both patients and providers.

CSRO urged the Administration to leverage its enforcement and regulatory authority to address these issues and proposed several immediate policy recommendations. These included revisiting rulemaking for the court-vacated 2021 Notice of Benefit and Payment Parameters, which allowed plans to use copay accumulator adjusters, and issuing regulations on non-essential health benefit policies for self-funded and large-group plans.

Legislation Around the Country

LA: CSRO Testifies and Fights Against Copay Maximizer Program Policy

Last week, Madeline Feldman, MD, FACR, Vice President of Advocacy & Government Affairs for CSRO, testified before the Senate Insurance Committee against a payer-backed amendment to a PBM transparency bill. This amendment would have explicitly authorized copay maximizer programs in the state. Dr. Feldman made clear that approving the amendment would represent a significant step backward for patient protections — particularly considering the state's recent landmark law banning copay accumulator programs. When questioned by the Committee, Dr. Feldman effectively countered the payers' primary argument that removing copay maximizer programs would increase patient premiums. Instead, she redirected the conversation to what matters most: copay maximizer programs raise patients’ out-of-pocket costs by an average of 51%. Her testimony proved decisive, persuading the full committee to strip the amendment from the bill before its committee passage

Given strong lobbying efforts by health plans in favor of the amendment, CSRO remains vigilant and continues to advocate as the bill advances toward a final Senate Floor vote. To draw a clear line against any last-minute maneuvers, CSRO and the Rheumatologic Alliance of Louisiana (RAL) submitted a joint letter forcefully opposing any attempts to reinstate language permitting copay maximizer programs before the bill's final passage. In tandem, Dr. Feldman developed a targeted educational issue brief equipping partners on the ground with the facts needed to counter health plan misinformation — setting the record straight on the real, documented harms copay maximizer programs impose on patients and ensuring senators have accurate information as they cast their votes.

MI: CSRO and MRS Support Copay Accumulator Program Ban Bill

On Tuesday, CSRO and the Michigan Rheumatism Society (MRS) submitted written testimony to the Senate Committee on Finance, Insurance, and Consumer Protection in support of Senate Bill 914, legislation that would ban harmful copay accumulator adjustment programs in Michigan. Copay accumulator adjustment programs prevent copay assistance — funds provided to help patients afford specialty drugs — from counting toward patients' deductibles and out-of-pocket maximums, leaving patients with unexpected, out-of-pocket costs. Senate Bill 914 would close this gap and ensure that every dollar of copay assistance goes to the patient as intended.

As a member of the All Copays Count Coalition, CSRO has supported advancing this policy throughout the session — working closely with coalition partners to identify a new bill sponsor and pushing back against aggressive lobbying by health plans seeking to block the bill's introduction in the state. Leading the charge on the ground, CSRO board member, Amar Majjhoo, MD, FACR, leveraged his role as President of the Michigan Rheumatism Society to notify local coalition partners ahead of the hearing, amplifying the voices of patients and providers in support of this measure.

What's Happening in the States

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.

Click above to access CSRO’s new State Legislative Tracker to find the status of CSRO’s priority legislation affecting the rheumatology community and its patients at the state level.

Business of Rheumatology Seminar Series - Decoding the “Big Beautiful Bill”: Practical Strategies for Rheumatology Practices: July 1, 2026

Join us for a timely and informative webinar exploring evolving payer strategies—including potential Medicare and Medicaid cuts—and what they could mean for practice sustainability, reimbursement, and patient access. This session is part of our ongoing webinar series, generously supported by Johnson & Johnson.

Register here!

Business of Rheumatology Seminar Series - Building a Clinical Research Program in Community Rheumatology Practice: September 16, 2026

Join us for the September Business of Rheumatology webinar as we discuss how practices can successfully engage in clinical research to improve patient care and support practice growth. This session is part of our ongoing webinar series, with support from Johnson & Johnson.

Register here!

Day on the Hill: October 2, 2026

Join us in Washington D.C. for CSRO's Day on the Hill! Register here.

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. Register here.

Business of Rheumatology Seminar Series - Smart Payer Contracting and Transparency in Coverage: December 2, 2026

Join us for our December Business of Rheumatology webinar to learn how to navigate payer contract negotiations with confidence. This session is part of our ongoing webinar series, generously supported by Johnson & Johnson.

Register here!

Fellows Conference: March 19-20, 2027

Calling all rheumatology fellows! Mark your calendars to join us in San Antonio, TX , for the CSRO annual Fellows Conference.

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.