Step Therapy Reform: Share Your Stories
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The State Access to Innovative Medicines Coalition (SAIM), which CSRO chairs, is collecting stories from those that have successfully utilized state laws to achieve an exception for their patients through a brief survey. The survey also requests a report of issues that patients and providers continue to have across the country regarding step therapy.
CSRO is asking you, our rheumatology community, to complete this brief survey to provide your input on step therapy reform, which will be used to:
- ensure the state laws are working for patients and providers
- provide updates to the state legislature and hard-working legislative leaders and sponsors who worked tirelessly on the bill and
- gain insight as to how well the state law is working to garner support for the federal bill
Any feedback you can provide will be a great help with advocacy efforts throughout the country this year - thank you in advance for your participation.
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Medicare Advantage and Part D Drug Pricing Final Rule: Pharmacy Price Concession
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Recently, CMS proposed a new rule addressing pricing concerns due to PBMs. Read our summary to learn more.
Insurance companies or their pharmacy benefit managers (PBMs) often receive compensation after the point-of-sale that lowers the final net amount they pay for the drug.
While manufacturer price concessions still account for the largest category, CMS is currently focusing on pharmacy price concessions by proposing two main changes.
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Advocacy: CSRO Leading Efforts to Curb White and Brown Bagging Mandates in the States
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Across the country, insurers are increasingly issuing specialty pharmacy mandates in the form of white and brown bagging policies. To combat these policies, the CSRO has heavily invested resources to support state legislation that would “ban” white and brown bagging requirements.
CSRO has hired council in Illinois and is leading the coalition to pass legislation in that state. We are also helping lead in similar white and brown bagging coalitions around the country that include Wisconsin, Ohio, and Tennessee. Overall, it is estimated that there will be bills in at least 12 states during the 2022 state legislative period, and we will continue to provide updates on these important advocacy efforts.
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White/Brown Bagging Survey Highlights |
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The CSRO recently distributed a survey to the rheumatology community to better gauge just how widespread white and brown bagging policies have become. Below are some highlights of the data we collected.
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Overall, 68% of respondents agreed that home infusion-based services significantly increase risk and safety concerns for patients.
In relation to white bagging:
- 82% of respondents have experienced white bagging mandates from payers
- 69% of respondents experienced operational and safety issues associated with white bagging
- 68% of respondents who experienced issues cited that medication delivery was delayed, which caused patients appointments to be canceled and increased the chances of drug waste
In relation to brown bagging:
- 54% of respondents have experienced brown bagging mandates from payers
- 80% of respondents experienced operational and safety issues associated with brown bagging
- 42% of respondents who experienced issues stated that the medication was improperly stored or transported to the office by the patient, resulting in drug waste and a delay in care
All of the information gathered will be used to support legislative and payer efforts to fight these policies - thank you to all who participated!
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Spotlight: Pharmacy Podcast Network
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The Truth About Pharmacy Benefit Managers
CSRO Board President Madelaine Feldman, MD, FACR, joined the Pharmacy Podcast Network for an episode of their PBM Reform series titled The Public Deserves the Truth about Pharmacy Benefit Managers to explain who PBMs are, what they do, and discuss the latest movements in PBM reform.
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Legislation Around the Country
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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.
Bills that need your support will include a link for you to take action by sending a message to lawmakers – customize our easy-to-use templates to make an impact on legislation.
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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ARIZONA
White Bagging
- SB 1161: Introduced and read for the first time in the Senate
DISTRICT OF COLUMBIA
Accumulator Programs
FLORIDA
Accumulator Programs
- SB 1480: Referred to Banking and Insurance, Health Policy, and Appropriations Committees
- HB 1063: Referred to Finance and Facilities Subcommittee, Health and Human Services, and Appropriations Committees
Step Therapy
- SB 730: Referred to Banking and Insurance, Health Policy committees
White Bagging
- SB 748: Referred to Banking and Insurance, Appropriations subcommittee on Agriculture, Environment, General Government, and Appropriations committees
INDIANA
Rebate Pass Through
- SB 88: Referred to Committee on Health and Provider Services
KENTUCKY
Rebate Pass Through
- HB 203: Introduced and referred to Committee on Committees
MAINE
Accumulator Programs
- LD 1783: Referred to Committee on Health Coverage, Insurance, and Financial Services
MISSOURI
Accumulator Programs
Step Therapy
Rebate Pass Through
- SB 814: Introduced and read for the first time
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NEBRASKA
Accumulator Programs
- LB 718: Referred to Banking, Commerce, and Insurance Committee
White Bagging
- LB 943: Referred to Banking, Commerce, and Insurance Committee
NEW HAMPSHIRE
- HB 1580: Introduced and referred to Commerce and Consumer Affairs Committee
NEW YORK
Accumulator Programs
- S5299: Died in assembly
- A1741: Ordered to third reading
White Bagging
- S 7252: Referred to Insurance
White-bagging
- HB 451: Referred to House Insurance Committee
WASHINGTON
Accumulator Programs
- SB 5610: Scheduled for Public Hearing on 1/19/22
- HB 1713: Referred to Health Care & Wellness Committee
WISCONSIN
White-Bagging
- AB 718: Referred to Committee on Health
- SB 753: Hearing scheduled for 1/20/22
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Take Action: AB718 & SB753
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Registration Now Open!
Save the Date!
Find all of CSRO's event dates by visiting our Upcoming Events page, and check out past events and webinars in our Library.
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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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