On Capitol Hill

CSRO Submits Feedback to CMS on Medicare Payment Proposals for Physicians, Hospitals

Recently, CSRO submitted comments to the Centers for Medicare and Medicaid Services (CMS) on both the CY 2026 Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) proposed rules. In its PFS comments, CSRO welcomed increased payment updates but urged CMS to work with Congress on a long-term fix to Medicare physician payment updates that account for inflation, raised strong objections to the application of a proposed efficiency adjustment on drug administration services, and warned that ASP-related policies risk worsening access to biologics and biosimilars. In its OPPS letter, CSRO voiced support for applying site-neutral payment rates to drug administration services furnished in excepted off-campus provider-based departments, stressing that the current payment differential fuels hospital consolidation and raises costs for Medicare and patients, while incentives in the 340B program further encourage hospitals to acquire physician practices and convert them into higher-paying outpatient departments.

OIG Responds to Coalition Letter on Step Therapy Oversight

Yesterday, the Office of Inspector General (OIG) responded to a coalition letter submitted earlier this year by more than 60 provider and patient organizations, including CSRO, urging oversight of Medicare Advantage plans’ use of step therapy for Part B drugs. CSRO provided rheumatology-specific examples, largely focused on the impact of manufacturer rebates to secure “fail first” position on MA plan formularies, which restricts access to other therapies that may be more appropriate. In its reply, OIG acknowledged concerns about the impact of step therapy on clinical decision-making, patient access, and health outcomes, noting it would consider the coalition’s perspectives as it explores potential new oversight work.

Dr. Madelaine Feldman, CSRO Advocacy Leader, Serves as Key Speaker at Congressional Briefing on AFPs

Madelaine Feldman, MD, FACR, Vice President of Advocacy and Government Affairs for CSRO, was invited to serve as a panelist during a congressional briefing on Alternative Funding Programs (AFPs). The briefing was hosted by Representatives Rick Allen (R-GA) and Lucy McBath (D-GA), who opened the session by sharing their personal experiences with cancer and other health challenges, underscoring the importance of timely access to appropriate care and the deceptive nature of AFPs. Dr. Feldman joined panelists from CancerCare, the Hemophilia Alliance, Hope Charities, and the National Alliance of Healthcare Purchasers Coalition to educate congressional offices about AFPs and the serious harm they pose to patients. Representing CSRO, Dr. Feldman provided the only physician perspective on the panel, highlighting the critical clinical implications of these programs.

Legislation Around the Country

Uniting State Rheumatology Societies: CSRO Hosts Annual Advocacy Conference in Dallas

On September 12–13, 2025, CSRO hosted its annual Advocacy Conference in Dallas, Texas. This event gathered representatives from various state rheumatology societies for an important policy forum. The conference kicked off on Friday evening with a cocktail reception and dinner, featuring guest speaker Texas State Representative Tom Oliverson, MD, an anesthesiologist and long-time advocate for healthcare. Saturday’s agenda was packed with policy discussions led by national healthcare experts on CSRO's key priorities, including pharmacy benefit managers (PBMs), biosimilars, and insurance reform. Attendees also heard from former U.S. Congressman Michael Burgess, MD, who shared insights on how state societies can effectively advocate for physician issues at both state and federal levels. CSRO leadership and staff provided updates on the organization’s policy priorities at the state and federal levels, considering the current political dynamics. Before concluding with the Annual Business Meeting, CSRO board members facilitated breakout sessions with state society leaders and members. These discussions provided valuable opportunities to exchange advocacy best practices and gain a deeper understanding of the unique challenges and priorities facing rheumatology societies nationwide.

CA: CSRO Urges Governor Newsom to Sign Rebate Pass-Through Bill into Law

On Monday, CSRO sent a letter to Governor Newsom urging him to support and sign Senate Bill 41 into law. This important legislation, which passed both the Assembly and the Senate last week, requires pharmacy benefit managers (PBMs) to pass all manufacturer rebates directly to health plans and insurers. This measure addresses the lack of transparency and potential conflicts of interest in the current rebate system. Additionally, the bill enhances transparency requirements and protects patients from steering and discrimination by PBMs. CSRO emphasized the importance of this legislation in ensuring that savings intended for patients are not redirected to PBMs.

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): Adjourned 09/12

MA

• Step Therapy (HB1128): Hearing rescheduled to 09/09/2025 from 10:30 AM-12:30 PM in A-2 and Virtual Hearing updated to New End Time
• Step Therapy (SB708): Hearing rescheduled to 09/09/2025 from 10:30 AM-12:30 PM in A-2 and Virtual Hearing updated to New End Time

MI

• 340B Drug Pricing Program (HB4878): bill electronically reproduced 09/11/2025

NH

• Prescription Drug Affordability Board (HB570): Adjourned 06/26

OH

• Rebate Pass Through | PBM Reform (HB448): Introduced

WI

• 340B Drug Pricing Program | Copay Accumulator Adjustment Program Ban | PBM Reform | Step Therapy (AB173): Representative Donovan added as a coauthor
• Copay Accumulator Adjustment Program Ban |Maximizer Program Ban | Non-Medical Switching (SB203): Representative Sinicki added as a cosponsor
• Prior Authorization (AB432): Read first time and referred to Committee on Health, Aging and Long-Term Care



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!

Virtual Advocacy Day: October 8, 2025

Save the date 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.