Mission-Focused: CSRO Advocating for You
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CSRO Amplifies Local Medicare Policy Development Concerns with CMS |
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Rheumatologists expressed their ongoing concerns with the process for developing local coverage policies, including local coverage articles (LCAs), without input from practicing clinicians during a stakeholder meeting with the Centers for Medicare and Medicaid Services (CMS) last week. Joined by 17 other medical specialty societies, CSRO highlighted the lack of a formal process for soliciting feedback on LCAs that – despite being dubbed as “billing and coding guidance” – have the effect of materially altering coverage and payment, and thus access to care, for medically necessary services.
In her remarks to the agency, CSRO President Madelaine Feldman, MD described the rheumatology organization's year long-effort to correct a problematic LCA for complex chemotherapy administration that requires practices to “down code” their complex drug administration services when certain medications are used. “Most of the drugs for which these flawed policies apply require the same level of physician supervisions, cost the same to administer, have the same rate of adverse events, and are not substantively different from the first biologics that were specified in regulation as warranting the use of the complex chemotherapy administration service codes,” Feldman explained.
CSRO, along with other stakeholders, urged CMS to establish policies that would improve the dialogue between CMS, its contractors, and the physician community, which CSRO suggested as the underlying issue. CSRO continues to engage with CMS on this and other local coverage and policy issues, and will keep you updated.
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CSRO Testifies on Priority Issues in KY and WI |
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CSRO has been busy helping to support legislation important to the rheumatology community across the states, and in particular, are heavily engaged on the ground in Kentucky and Wisconsin.
The Wisconsin legislature is currently considering two bills that CSRO has made a priority, both of which were heard in Committee on February 16 with testimony from CSRO supporting both.
The first, AB 184, would prohibit state regulated plans from using accumulator adjustment programs, which threaten patients’ ability to afford medically necessary drugs. The second, AB 718, would prohibit payers from mandating the use of white bagging by practices in Wisconsin. Dr. Albert (pictured above), a Wisconsin rheumatologist, testified in support of this legislation to provide the unique perspective that private rheumatology practices have on this issue.
CSRO is also leading a coalition of advocacy organizations to support SB 140 in Kentucky, which will update the state’s law related to step therapy. The legislation will provide prescribers additional flexibility in requesting exceptions from a step therapy protocol. SB 140 was heard in the Senate Banking and Insurance committee on February 15, and CSRO appeared virtually to lend support for the legislation. CSRO is pleased to report that the legislation was approved unanimously and proceeded to the House.
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Calling All Fellows: Online Registration Extended to March 4
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Take charge of your professional development and attend CSRO's annual Fellow Conference on March 19. Specially designed for the rheumatology community, join us for insight on critical issues and skills not taught in academic training.
This free conference will feature sessions on early career financial management, important issues in coding, and the realities of private practice, all presented by field experts.
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Advocacy Webinar: Obtaining an Override from Insurers & Employers
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Are you feeling the burdens of Payer and PBM mandates to 'white bag' infusion drug? Join CSRO on March 10 for a 30-minute webinar to learn how to move through their roadblocks while educating employers on these harmful practices.
Moderated by CSRO President Dr. Madelaine Feldman, CSRO Insurance Committee members Julie Baak, Nilsa Cruz and Karen Ferguson will review the request and appeal process, sharing their experience on-the-job to arm attendees with solutions and options for their patients.
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Thursday, March 10
5pm CT / 6pm ET
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Spotlight: News From CSRO
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The decisions Pharmacy Benefit Managers (PBMs) make often result in vital drugs being unaffordable for many patients. In the last four years, the three biggest PBMs have consolidated influence in the U.S. health care marketplace through vertical integration with insurance carriers, leading to increased prescription drug costs.
Read more in this collaborative piece by CSRO President Dr. Madelaine Feldman, Board Members Dr. Harry Gewanter and Dr. Robert Levin, and CSRO Founder Dr. Michael Schweitz in Healio Rheumatology. |
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The Winter edition of CSRO's bi-annual Policy Update is here! The newsletter is now available on our website and features exclusive updates on CSRO's state and federal advocacy activity.
If you're interested in a more in-depth discussion of the content shared in this edition, we encourage you to save the date for our State Society Advocacy Conference September 9-10.
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Legislation Around the Country
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ICYMI: Opportunity For Action in Your State
The following states have active legislation that need your support - make your voice heard today:
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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. For a full status report on all the bills CSRO tracks, click here.
Be sure to check out our interactive legislative map tool for additional information about current policy in your state. Plus, don't forget to add your state to your email profile here to receive state-specific updates and action alerts via email. |
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ALASKA
Rebate Pass Through
- SB 210: Introduced and referred to Labor and Commerce, Finance committees
DISTRICT OF COLUMBIA
Accumulator Programs
- B24-0557: Hearing scheduled for 3/7/2022
CALIFORNIA
Rebate Pass Through
- AB 2942: Introduced, hearing tentatively scheduled for 3/21/2022
Step Therapy
- AB 1880: Referred to Committee on Health
White Bagging
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SB 958: Referred to Committees on Health and Judiciary
HAWAII
Accumulator Programs
- SB 2443: Approved by Senate Committee on Commerce and Consumer Protection
ILLINOIS
White Bagging
- SB 3924: Re-referred to Assignments
IOWA
Rebate Pass Through
- HSB 623: Subcommittee recommends passage renumbered as HF 2384
- HF 2384: Introduced and placed on the House calendar
KENTUCKY
Prior Authorization “Gold Card”
- HB 343: Referred to Health and Family Services Committee
Step Therapy
- SB 140: Passed the Senate and arrived in the House
MASSACHUSETTS
White Bagging
- SB 695: Reported favorably and referred to committee on Healthcare Financing
MISSOURI
Step Therapy
- SB 959: Referred to Insurance and Banking committee
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NEBRASKA
Accumulator Programs
- LB 767: Advanced to Enrollment and Review for Engrossment and placed on Final Reading
NEW HAMPSHIRE
Rebate Pass Through
- HB 1580: Executive Session scheduled for 3/3/2022
OKLAHOMA
Rebate Pass Through
- SB 1324: Reported do pass as amended by Senate committee
- HB 3493: Referred to Rules and Withdrawn from Appropriations and Budget committee
- HB 3492: Referred to Rules and Withdrawn from Appropriations and Budget committee
- HB 4087: Introduced, withdrawn from Rules, referred to Appropriations and Budget committee
SOUTH CAROLINA
Accumulator Programs
- H 4987: Introduced and referred to Committee on Ways and Means
TENNESSEE
Step Therapy
- HB 677: Placed on Insurance Subcommittee calendar for 3/1/2022
UTAH
Accumulator Programs
- SB 139: Placed on Senate second reading Calendar, referred to Senate Rules Committee
WASHINGTON
Accumulator Programs
- SB 5610: Executive action taken by House Health Care & Wellness committee, referred to Rule for review
WISCONSIN
Accumulator Programs
- AB 184: Public hearing held on 2/16/2022
White Bagging
- AB 718: Public hearing held on 2/16/2022
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CSRO is a 501c3 nonprofit organization dedicated to ensuring access to the highest quality care for the management of rheumatologic diseases - donate today.
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