President Donald Trump signed the One Big Beautiful Bill Act (H.R. 1) into law on Friday, July 4th, enacting a comprehensive $3.4 trillion tax and spending package. This significant piece of legislation was strategically structured as a budget reconciliation package to circumvent Senate filibuster rules. After a vote-a-rama on amendments to the bill, the Senate narrowly passed the reconciliation package with a final vote of 51-50. Senate Republicans Rand Paul (KY), Thom Tillis (NC), and Susan Collins (ME) voted against the bill with Democrats, resulting in Vice President JD Vance casting the tie-breaking vote. After Senate passage, House GOP leadership quickly mobilized support among concerned moderate and fiscally conservative Republicans, assuaging their apprehensions about the Senate version of the bill, which facilitated its passage in the House after an intensive 24 hours of deliberation. The bill then quickly made its way to the President, who signed it just in time to meet the Republicans' self-imposed deadline for Independence Day.

The budget reconciliation bill includes a one-year Medicare payment adjustment aimed at increasing physician reimbursements by 2.5% in 2026. CSRO is disappointed in Congress's failure to implement a long-term solution to the Medicare Physician Fee Schedule, which would safeguard against future payment cuts. The Coalition continues to advocate for urgent action to address the 2.83% payment cut scheduled for 2025, which took effect on January 1. That’s why CSRO supports policies such as the Medicare Patient Access and Practice Stabilization Act, which would raise the Medicare physician payment conversion factor for the remainder of 2025 to address current inflationary pressures on physician practices.

H.R. 1 also includes other healthcare measures, such as expanded exemptions for orphan drugs targeting rare diseases as part of the Medicare Drug Price Negotiation Program, which is set to commence in 2028. Furthermore, the bill will also significantly impact Medicaid with roughly $1 trillion in cuts and the establishment of new work requirements for beneficiaries aged 19-64 who do not fall within exempted groups outlined in the bill. To ensure continued access to rural and underserved areas despite these historical Medicaid cuts, the new law allocates a $50 billion fund dedicated to supporting rural hospitals.

No UPCODE Act: CSRO Supports Legislation to Stop Overpayments by Medicare Advantage Plans   

On July 2, the CSRO joined the Alliance of Specialty Medicine in sending a letter of support for the reintroduction of S. 1105, the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act. This bipartisan legislation aims to reduce upcoding by Medicare Advantage plans, a measure projected to save taxpayers approximately $124 billion over the next ten years. Unlike traditional Medicare, which reimburses physicians based on the treatments provided, Medicare Advantage plans receive a standardized payment rate that is adjusted for each patient's health status. This structure creates an incentive for these plans to portray beneficiaries as sicker than they really are to receive higher payments, resulting in widespread abuse and fraud. S. 1105 seeks to address this issue by closing the gap in how patients are evaluated under traditional Medicare compared to the Medicare Advantage program. The bill would also establish a new two-year risk adjustment model to more accurately assess patients’ medical conditions.

Advocacy Conference: Spots Filling Fast - Register to Join Us in September    

Join CSRO this September 12-13 in Dallas, Texas, for our annual Advocacy Conference! This free event offers the opportunity to connect with others in the rheumatology community, hear from policy experts, and stay informed on the issues shaping our field.

The curated program includes sessions highlighting current issues impacting patients and practices, like a deep dive into upcoming federal policy changes, state-level advocacy wins, and the real-world impact of PBM and insurance practices on patient care. Our keynote presentation will also feature Wendell Potter, a nationally recognized health care reform advocate.

Visit the event webpage to view our full program and learn more. Space is limited and the room block is filling up fast – sign up now to secure your spot! 

Legislation Around the Country

LA: CSRO Urges Governor to Call for Special Session on PBM Reforms

Until the final hours of the 2025 legislative session, CSRO remained actively engaged in advocating for meaningful PBM reforms, including policy that would delink PBM compensation from prescription drug pricing. The Coalition was disappointed to see PBM reform legislation fail in the Senate just as the session was closing, but was encouraged by public statements from Governor Jeff Landry indicating his continued support for the issue and potential plans to call for a special session. In response, Louisiana native and CSRO's Vice President of Advocacy & Government Affairs, Dr. Madelaine Feldman, met with a senior staffer for the Governor to discuss the importance of delinking and other critical reforms. The CSRO and the Louisiana Rheumatology Alliance also submitted comments to Governor Landry, showcasing strong support from the rheumatology community for a special session focused on addressing PBM reforms. 

IL: Governor Signs into Law PBM Reform Bill with Rebate Pass Through Requirements

On July 3, Illinois Governor J.B. Pritzker signed into law the Prescription Drug Affordability Act (H.B. 1697), a comprehensive PBM reform bill aimed at lowering prescription drug prices for patients. CSRO was pleased to see that the bill mandates a 100 percent rebate pass-through to either the health plan, individual, or employer. Additionally, it requires PBMs to report annually to the state on the rebates they receive. H.B. 1697 also prohibits PBMs from directing patients to their affiliated pharmacies and bans spread pricing practices.

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

• 340B Drug Pricing Program (AB1460): In committee: Set, second hearing. Hearing canceled at the request of the author.
• PBM Reform (SB41): Vetoed by Governor Newsom in 2024

DE

• Prior Authorization (SB12): Passed By House.

IL

• PBM Reform | Rebate Pass Through (HB1697): Adjourned Sine Die 04/04

MA

• Prior Authorization (SB1403): Discharged to the committee on Health Care Financing
• Prior Authorization (HB1383): Hearing scheduled for 07/15/2025 from 10:00 AM-04:00 PM in Gardner Auditorium
• Prior Authorization (HB1136): Hearing scheduled for 07/15/2025 from 10:00 AM-01:00 PM in A-2
• PBM Reform (SB2538): Reprinted, as amended, see S2543

ME

• 340B Drug Pricing Program (SP435): Died in Possession of the Senate when the Legislature adjourned Sine Die and was PLACED IN THE LEGISLATIVE FILES. (DEAD)
• Prior Authorization | Biomarker Testing Coverage (HP72): CARRIED OVER, in the same posture, to any special or regular session of the 132nd Legislature, pursuant to Joint Order SP 800.
• Maximum Fair Price limit (SP314): PASSED TO BE ENACTED, in concurrence.

NC

• PBM Reform (S479): Pres. To Gov. 6/30/2025

NH

• Biosimilars (HB117): Without Objection, the Clerk is authorized to make technical and administrative corrections which are necessary to reflect the intent of the Senate, MA; 06/05/2025; SJ 15

NJ

• Copay Accumulator Adjustment Program Ban | Alternative Funding Program Ban | Maximizer Program Ban (A5217): Senate Amendment (Voice) (Ruiz)
• Maximizer Program Ban | Alternative Funding Program Ban | Copay Accumulator Adjustment Program Ban (S3818): Senate Amendment (Voice) (Ruiz)

OR

• 340B Drug Pricing Program (SB533): At President's desk upon adjournment.

RI

• Prior Authorization (S168): Signed by Governor
• 340B Drug Pricing Program (H5634): Signed by Governor
• 340B Drug Pricing Program (S114): Signed by Governor

Business of Rheumatology: August 20, 2025

CSRO's virtual seminar series to help support rheumatology practices in building and strengthening their business.

Advocacy Conference: September 12-13, 2025

Register now to join us in Dallas, Texas, for CSRO's annual Advocacy Conference! 

Virtual Advocacy Day: October 8, 2025

Save the date to advocate alongside CSRO as we host live conversations with health care leaders. Be notified when registration launches by clicking 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.

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.