CSRO Unites Rheumatology Advocates and Lawmakers at Virtual Advocacy Day | | |
CSRO hosted its Virtual Advocacy Day on October 8, inviting all state rheumatology organizations to engage in discussions with prominent voices in Congress regarding healthcare issues. Over 75 rheumatologists and practices partners from various state organizations participated in policy-focused conversations with 12 members of Congress from both political parties and chambers. Guest speakers included Senator Roger Marshall, MD (R-KS), and Representatives Kim Schrier, MD (D-WA), Mariannette Miller-Meeks, MD (R-IA), Andy Harris, MD (R-MD), Buddy Carter (R-GA), Rich McCormick, MD (R-GA), Herb Conaway, MD (D-NJ), Kat Cammack (R-FL), Judy Chu (D-CA), Jennifer McClellan (D-VA), Michael Rulli (R-OH), and Neal Dunn, MD (R-FL).
Participants had the chance to hear directly from congressional members and ask questions about the impact of the government shutdown on the nation. They also discussed efforts to advance the federal policy priorities of CSRO, including reforms for pharmacy benefit managers (PBMs) and prior authorization, copay accumulator program bans, and addressing the issue of underwater biosimilars.
| | Government Shutdown Continues, Medicare Extends Temporary Claims Hold | |
On October 1, 2025, a partial federal government shutdown took effect, with at least half of the Centers for Medicare and Medicaid Services (CMS) staff furloughed. As a result, nonessential activities including policy and rulemaking, most survey and certification activities, and outreach and education have been paused. While certain mission-critical functions continue, CMS has instructed its Medicare Administrative Contractors (MACs) to hold certain claims with dates of service on or after October 1, 2025, that have been impacted by the expired Medicare provisions in the Full-Year Continuing Appropriations and Extensions Act, 2025, and specifically, select telehealth flexibilities and the 1.0 work geographic practice cost index (GPCI) floor. The claims hold “prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date” to extend these provisions, according to the Agency. CMS also emphasized that the claims hold is consistent with the statutory 14-day payment floor, that no payment delays have occurred, and that providers may continue submitting claims as usual.
As a reminder, until Congress acts on the telehealth provisions, beneficiaries are again limited to receiving telehealth services from qualifying “originating sites” in eligible rural areas, with few exceptions. CMS advises practitioners furnishing non-payable telehealth services to consider issuing an Advance Beneficiary Notice of Noncoverage (ABN).
| | Legislation Around the Country | CSRO Testifies Against Colorado’s Upper Payment Limit (UPL) on Enbrel | | |
Earlier this month, CSRO’s Vice President of Advocacy and Government Affairs, Madelaine Feldman, MD, FACR, publicly testified along with other providers, patients, and pharmacists before the Colorado Prescription Drug Affordability Board in opposition to an upper price limit (UPL) on the rheumatoid arthritis prescription drug, Enbrel. Dr. Feldman cautioned that implementing a UPL for Enbrel could lead to PBMs and health plans manipulating their formularies, making the medication less accessible for patients.
Despite strong objections from various healthcare stakeholder groups during the hearing, the PDAB voted in favor of establishing a UPL on Enbrel. This decision makes Colorado the first state in the nation to impose such a price control on a prescription drug. The PDAB set the price cap for Enbrel at the same level as the Maximum Fair Price (MFP) negotiated at the federal level for drug manufacturers under Medicare Part D, which amounts to roughly one-third of the drug's list price. The UPL on Enbrel is scheduled to take effect on January 1, 2027.
| OH: CSRO Testifies on HB 276, Highlighting 340B Program’s Impact on Rheumatology Practices | |
Earlier this week, CSRO submitted written testimony in advance of the Ohio Insurance Committee's hearing on HB 276, which addresses certain aspects of the federal 340B drug pricing program. In its testimony, CSRO expressed concerns about provisions in the bill that would allow unrestricted access to contract pharmacies. Such provisions in most instances fail to serve underserved, low-income, and uninsured patients as originally intended with the program.
The testimony highlighted issues regarding how the 340B program has contributed to increased healthcare consolidation, which threatens the viability of independent physician practices, including rheumatology practices.. CSRO urged the Committee to focus on realigning the 340B program by prioritizing patients and establishing greater transparency and accountability to ensure the program's success as outlined in its position statement.
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Want to learn more about the legislation introduced in your state? Visit CSRO’s Map Tool to find all of the new and enacted bills within CSRO’s policy priorities.
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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. | | |
CA
- Rebate Pass Through | PBM Reform (SB41): Signed into law by the Governor (10/11)
NH
- Prescription Drug Affordability Board (HB570): Executive Session: 10/30/2025 10:00 am GP 230 (H)
WI
- 340B Drug Pricing Program | Copay Accumulator Adjustment Program Ban | PBM Reform | Step Therapy (AB173): Senator Carpenter added as a cosponsor
- Copay Accumulator Adjustment Program Ban |Maximizer Program Ban | Non-Medical Switching (SB203): Senator Carpenter added as a coauthor
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Making Patient Experiences Heard | CSRO advocacy efforts work to ensure patient drug affordability and access to care. Together with the EACH Coalition, we’re looking to make patient experiences heard. Encourage your patients to tell us about their drug affordability experiences by participating in this survey! | | Mark Your Calendar: Upcoming Events
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2025 CSRO Advocacy Town Hall: November 19 at 7pm CT
Join CSRO leadership as we gather with the rheumatology community for a virtual Town Hall. Register here!
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2025 CSRO Business of Rheumatology Series: December Date TBD
We will conclude our 2025 BOR seminar series this December. Stay tuned for details on the session and topic!
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2026 CSRO State Legislative Forecast: February 11 at 7pm CT
Kick off the year with CSRO as we gather virtually to provide updates on our state policy priority issues and look at what's ahead during the 2026 state legislative session. Register here!
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2026 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.
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2026 Advocacy Conference & Day on the Hill: October 2-3, New Date!
Save the date to join us next year in Washington D.C for our next Advocacy Conference. New in 2026, the event will also feature an in-person advocacy day!
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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
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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.
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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.
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