Coalition Urges Congress to Enact PBM Reforms After Longest Government Shutdown | | After the longest government shutdown in U.S. history, CSRO joined a diverse coalition of patient, provider, and employer organizations to urge Congress to pass comprehensive PBM reforms before the end of the year. The letter emphasized that three PBMs control and process nearly 80 percent of prescription drug claims, leading to healthcare consolidation that harms patients and drives up drug prices. The coalition called for the inclusion of four key policy provisions in the PBM reform package: 100% rebate pass-throughs, delinking PBM compensation from drug list prices, implementing transparency requirements for PBM business arrangements, and banning spread pricing. Read the coalition letter here. | CSRO Hosts Advocacy Town Hall to Update Membership on CSRO’s 2025 Advocacy Work | | On November 19, CSRO leadership held a virtual Advocacy Town Hall to inform state rheumatology societies about the Coalition's advocacy initiatives to support rheumatology practices and patients at the federal, regulatory, and state levels. More than 40 attendees heard directly from CSRO’s government affairs team regarding recent advocacy actions by the Trump Administration and Congress that affect medical practice. Participants learned about CSRO's efforts in Washington, DC, and across all 50 states to promote key advocacy priorities, including 340B drug program pricing, utilization management, and pharmacy benefit manager (PBM) reforms. The presentation also outlined potential changes in the political landscape for rheumatologists in 2026. If you missed the live town hall, you can watch the presentation at any time here. | | Legislation Around the Country | Dr. Feldman Speaks on behalf of CSRO and the National Foundation for Women Legislators Annual Conference | | |
Madelaine Feldman, MD, Vice President of Advocacy & Government for CSRO, was invited to speak at the National Foundation for Women Legislators Annual Conference. She participated in a panel discussion titled "Turning Discovery into Access: The Policy Fight for Biomarker Testing." The presentation was moderated by Arkansas Representative Mary Bentley, and Dr. Feldman shared the stage with representatives from the Alzheimer’s Association, the Alzheimer’s Impact Movement, and Eli Lilly.
During her presentation, Dr. Feldman emphasized the critical importance of covering biomarker testing to ensure patients receive timely, personalized care for autoimmune diseases, cancer, Alzheimer’s, Parkinson’s, and other conditions. She explained that finding the right treatment for patients with rheumatologic conditions often involves a lengthy and painful process of trial and error, which could be significantly streamlined with comprehensive coverage for biomarker testing. The discussion also addressed the inconsistent coverage of biomarker testing across states and the urgent need to expand nationwide access to such testing to prioritize patient interests. Dr. Feldman highlighted CSRO’s advocacy efforts to advance legislation that mandates insurance plans to cover biomarker testing if the tests have demonstrated their clinical utility through validation.
| CO: Coalition Calls for Consistent Implementation of Colorado’s Biomarker Testing La | Last month, CSRO joined a coalition letter led by the American Cancer Society Cancer Action Network addressed to the Colorado Division of Insurance. This letter discusses the Division’s draft bulletin on coverage for biomarker testing in individual and small-group health plans. In the previous year, Colorado passed SB 24-124, which requires coverage for biomarker tests that are essential for diagnosing and treating a covered individual’s disease or condition, provided the testing is medically necessary and supported by medical evidence. The coalition’s comments showed support for the Insurance Division’s efforts to implement this new law and acknowledged its position that it will not trigger financial defrayal for individual and small-group health insurance plans. The comments also suggested changes to the proposed medical-necessity language to ensure that insurers do not establish additional medical-necessity criteria beyond those outlined in the statute. | |
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. | | |
NH
- Biomarker Testing Coverage | Prior Authorization (SB606): To Be Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1
- PBM Reform (SB547): To Be Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1
- Prior Authorization (SB544): To Be Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1
- Step Therapy | PBM Reform (SB478): To Be Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1
OH
- Rebate Pass Through | PBM Reform (HB448): House Insurance: 1st Hearing
WI
- 340B Drug Pricing Program | Copay Accumulator Adjustment Program Ban | PBM Reform | Step Therapy (AB173): Senator Carpenter added as a cosponsor
- Maximizer Program Ban | Copay Accumulator Adjustment Program Ban | Non-Medical Switching (SB203): Representative J. Jacobson added as a cosponsor
| | Mark Your Calendar: Upcoming Events
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Join CSRO for the next Business of Rheumatology seminar supporting practices in strengthening their operations. This session will cover the new cap, its impact on patient access and affordability, and strategies to navigate the changing payment landscape. Register here! Special thanks to Johnson & Johnson for sponsoring this series.
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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!
| | Important Security Notice: Phishing Email Alert | |
We have observed a rise in phishing email attempts. These emails may appear to come from trusted sources but often contain malicious links, attachments, or requests for sensitive information. To protect yourself and your state society, please exercise caution and verify emails carefully before taking any action.
Please keep the following in mind:
- Always double-check the sender’s email address for legitimacy—beware of slight misspellings or unusual domains.
- Hover over any links to confirm their true destination before clicking.
- Be cautious of unexpected attachments or urgent requests demanding personal or financial information.
- If you receive a suspicious email, do not respond or click any links; instead, promptly report it to the IT or security team.
Maintaining vigilance against phishing helps safeguard our data and systems. Thank you for your attention to this important matter.
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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.
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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