This week, Congress returned from a two-week recess and is working to draft and mark up a reconciliation bill. The House Energy & Commerce Committee is expected to mark up its section of the package as soon as Wednesday, May 7. Eventually, the budget committee will assemble the drafted legislation from all committees and combine them into a single legislative package that the House will vote on. If the House advances the legislation with a simple majority, it will be sent to the Senate for possible amendment and consideration. House and Senate Republicans are currently working on finalizing the components of the multi-trillion dollar policy bill.

Reconciliation enables Congress to bypass the 60-vote threshold normally required to advance legislation in the Senate. CSRO is closely watching to see if some of its key healthcare priorities are included in the package, including a fix to the Medicare Physician Fee Schedule and bipartisan PBM provisions. However, only policies with a direct budgetary effect can pass the Byrd rule, which would include Medicare Part D delinking, rebate pass through and spread pricing. PBM provisions in the commercial market would not be eligible for consideration under reconciliation. CSRO also supports revisions to the Inflation Reduction Act, including the EPIC Act and Protecting Patient Access to Cancer and Complex Therapies Act, which could also be considered for the package. The House Energy & Commerce Committee has been tasked with finding $880 billion in savings over the next 10 years, which will be impossible to achieve without some cuts to the Medicaid program.

Speaker Johnson has said he wants to pass the package by Memorial Day. However, a more likely deadline is the date at which the U.S. Treasury sets for the expiration of “extraordinary measures” related to the debt ceiling, as the package will serve as the vehicle for raising the nation’s borrowing limit.

In a written statement to the House Ways and Means Subcommittee on Health following its hearing on Lowering Costs for Patients: The Health of the Biosimilar Market on April 8, CSRO outlined how rebate-driven ASP distortions and Medicare Advantage (MA) step therapy policies are jeopardizing patient access to physician-administered biosimilars and threatening the sustainability of the biosimilar market. CSRO emphasized that while biosimilars were intended to provide affordable alternatives to costly biologics, current reimbursement and coverage practices are instead creating barriers to adoption, disrupting patient care, and forcing physicians to absorb unsustainable financial losses or transfer patients to hospital settings.

CSRO urged Congress to work with CMS to develop solutions that ensure biosimilar reimbursement covers acquisition costs and to eliminate MA step therapy policies that leave patients without meaningful access to alternative therapies when preferred biosimilars are financially untenable.

Spotlight: Disruptive Dialogue with Chuck Melendi Podcast

CSRO's Vice President of Advocacy & Government Affairs, Dr. Madelaine Feldman, joined the Disruptive Dialogue with Chuck Melendi podcast to discuss pharmacy benefit managers and the broken healthcare system.

Find the episode, titled The Wake-Up Call - America's Broken Healthcare System on Apple, Spotify, YouTube, or wherever you get your podcasts!

Happening May 14: The Impact of Medicare Advantage & Part D on Private Practice

Log in on Wednesday, May 14, at 7pm CT / 8pm ET to join CSRO for our next Business of Rheumatology seminar focusing on the impact of Medicare Advantage and Part D!

The program will bring together perspectives from policy, practice management, and the pharmaceutical industry to explore how Medicare Advantage and Part D are influencing access to care, specialty medication availability, and the sustainability of private practices. Moderated by CSRO President Dr. Aaron W. Broadwell, our expert panel features:

• Meredith Hirsh – The Hirsh Center, CEO and Vice President
• James E. Mathews, PhD – Health Policy Alternatives, Principal
• Mike Ybarra, MD – PhRMA, Senior Vice President and Chief Medical Officer

Advocacy Conference: Join Us in September!

Advocating for patient access to care has been the cornerstone of CSRO's mission for more than two decades, and you're invited to join us this September 12-13 for our flagship Advocacy Conference in Dallas, Texas!

Attendees will gather with fellow advocates and members of the rheumatology community to learn, network, and strategize about advocacy. Our curated program will feature sessions highlighting current issues impacting patients and practices like the future of Medicare Advantage, biosimilars, PBM negotiations, and more.

Don't miss out! Registration is complimentary and open to anyone currently working within or retired from the field of rheumatology – visit our website to sign up now.

Legislation Around the Country

NJ: Biomarker Bill Signed into Law

Acting New Jersey Governor Tahesha Way signed legislation that requires State-regulated health insurers to cover biomarker testing, including those for rheumatologic care. CSRO worked alongside the American Cancer Society Cancer Action Network, the Medical Society of New Jersey, and other local advocates to advance this legislation. In an April letter to Governor Murphy, CSRO urged the Governor to sign this critical legislation into law as, “Biomarker testing is a pivotal advancement in precision medicine and an essential tool for rheumatologists and other physicians in determining the most effective treatment for individual patients based on unique biological information derived from proteins and genes.”

Under the bill, state-regulated health insurance providers, Medicaid, and the State Health Benefits Program and School Employees Health Benefits Program are required to provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition when the test is supported by medical and scientific evidence. The measure (A-4163/S-3098) was sponsored by Senators Vin Gopal (D-NJ-11) and Troy Singleton (D-NJ-07) and Assembly Members Shavonda Sumter (D-NJ-35), Gary Schaer (D-NJ-36), and Shama Haider (D-NJ-37).

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.

AK

• Prior Authorization (HB144): Cosponsor Senate: Himschoot
• Prior Authorization | Step Therapy (SB133):

CA

• 340B Drug Pricing Program (AB1460): Read second time. Ordered to third reading.
• Gold Card (SB306): Read second time and amended. Re-referred to Committee on Appropriations
• PBM Reform (SB41): From committee: Do pass and re-refer to Committee on Appropriations (Ayes 13. Noes 0.) (April 29). Re-referred to Committee on Appropriations
• Prior Authorization (AB512): Re-referred to Committee on Appropriations
• Prior Authorization (AB510): Re-referred to Committee on Appropriations
• Prior Authorization (AB539): Re-referred to Committee on Appropriations

CO

• 340B Drug Pricing Program (SB71): House Committee on Health & Human Services Witness Testimony and/or Committee Discussion Only
• Delinking | PBM Reform (HB1094): Senate Committee on Appropriations Refer Unamended to Senate Committee of the Whole

CT

• Biomarker Testing Coverage (HB6895): Referred by House to Committee on Appropriations
• Biomarker Testing Coverage (HB6771): Referred by House to Committee on Appropriations

DE

• Prior Authorization (SB6): Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits

HI

• 340B Drug Pricing Program (HB712): 48 Hrs. Notice (as amended CD 1) 04-30-25

IA

• Rebate Pass Through | PBM Reform (SF383): Read first time, passed on file. H.J. 1079.

IL

• 340B Drug Pricing Program (SB2385): Added as Co-Sponsor Sen. Sara Feigenholtz
• 340B Drug Pricing Program (HB3350): Added Co-Sponsor Rep. Elizabeth "Lisa" Hernandez
• Prescription Drug Affordability Board (SB66): Added as Co-Sponsor Sen. Doris Turner
• Prescription Drug Affordability Board (HB1443): Added Co-Sponsor Rep. La Shawn K. Ford

IN

• PBM Reform (SB140): Signed by the President of the Senate
• Step Therapy | Prior Authorization (SB480): Signed by the President of the Senate

LA

• PBM Reform (HB173): Read second time by title and referred to the Committee on Natural Resources.

MA

• Biomarker Testing Coverage (HB1227): Hearing scheduled for 04/29/2025 from 10:00 AM-02:00 PM in A-2
• Biomarker Testing Coverage (SB809): Hearing scheduled for 04/29/2025 from 10:00 AM-02:00 PM in A-2
• Copay Accumulator Adjustment Program Ban (HB1101): Flagged by Patients Not PBMs Coalition
• Copay Accumulator Adjustment Program Ban (SB698): Flagged by Patients Not PBMs Coalition

ME

• Rebate Pass Through | PBM Reform (HP682): Final Disposition - Ought Not to Pass Pursuant To Joint Rule 310, Apr 17, 2025

MI

• Prescription Drug Affordability Board (SB5): referred to Committee on Government Operations
• Prescription Drug Affordability Board (SB3): referred to Committee on Government Operations
• Prescription Drug Affordability Board (SB4): referred to Committee on Government Operations

MO

• Copay Accumulator Adjustment Program Ban (HB982): Reported Do Pass (H) - Ayes: 4 Noes: 3 Present: 1
• Copay Accumulator Adjustment Program Ban (SB45): Informal Calendar S Bills for Perfection
• Gold Card | Prior Authorization (SB230): Informal Calendar S Bills for Perfection

MT

• Prior Authorization (SB447): Returned from Enrolling

NC

• Biomarker Testing Coverage (H567): Re-ref Com On Rules, Calendar, and Operations of the House
• Non-Medical Switching (H434): Passed 3rd Reading
• PBM Reform (S479): Re-ref Com On Rules and Operations of the Senate
• Rebate Pass Through | PBM Reform (H163): Ref To Com On Rules and Operations of the Senate

ND

• Copay Accumulator Adjustment Program Ban (HB1216): Sent to Governor

NV

• Copay Accumulator Adjustment Program Ban | PBM Reform | Rebate Pass Through | Delinking (SB316): From printer. To engrossment. Engrossed. First reprint. To committee.
• Maximum Fair Price limit (AB259): From printer. To engrossment. Engrossed. First reprint. To committee.
• PBM Reform (SB389): From printer. To engrossment. Engrossed. First reprint. To committee.
• Prior Authorization (AB463): From printer. To engrossment. Engrossed. First reprint. To committee.
• Prior Authorization (AB290): From printer. To engrossment. Engrossed. First reprint. To committee.

OH

• Biomarker Testing Coverage (HB8): House Health: 3rd Hearing

OK

• 340B Drug Pricing Program (HB2048): Placed on General Order
• Biomarker Testing Coverage (HB1810): Placed on General Order
• Prior Authorization | Step Therapy (HB1808): Placed on General Order

RI

• Copay Accumulator Adjustment Program Ban (S477): Scheduled for consideration (05/01/2025)
• Maximum Fair Price limit (S468): Meeting postponed (04/24/2025)

SC

• Copay Accumulator Adjustment Program Ban | Alternative Funding Program Ban | Maximizer Program Ban (HB3934): Member(s) request name added as sponsor: Martin, Long, Govan, Gilliard, Bamberg, T.Moore

TN

• 340B Drug Pricing Program (SB1414): Transmitted to Governor for action.
• Biosimilars (HB1198): Signed by Governor (04/10/2025)
• Biosimilars (SB436): Comp. became Pub. Ch. 206

TX

• 340B Drug Pricing Program (HB3265): Reported favorably as substituted

WA

• Biosimilars | Non-Medical Switching (SB5594): Adjourned Sine Die 04/27

WI

• Step Therapy | 340B Drug Pricing Program | Copay Accumulator Adjustment Program Ban | PBM Reform (AB173): Fiscal estimate received

WV

Gold Card (SB833): Signed by Governor (04/24/2025)

Business of Rheumatology: May 14, 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.