On February 14, the Centers for Medicare & Medicaid Services (CMS) announced three new prescription drug-focused models for testing by the Innovation Center. The announcement was the result of President Biden’s Executive Order 14087, entitled Lowering Prescription Drug Costs for Americans.

The three models selected for testing by the Innovation Center are:

• Medicare High-Value Drug List Model: Under this model, Part D plans would be encouraged to offer a maximum $2 per-drug monthly copay across all phases of the drug benefit, for a standardized list of generic drugs that treat chronic conditions common among Medicare beneficiaries.
• Cell and Gene Therapy Access Model: Under this model, CMS would draft, coordinate, and administer outcomes-based agreements with drug companies on behalf of state Medicaid agencies, for certain cell and gene therapies. Each agreement could cover multiple states.
• Accelerating Clinical Evidence Model: Under this model, drugs approved pursuant to the Food and Drug Administration’s accelerated approval pathway would be subject to special payment methods, with the goal of encouraging timely completion of confirmatory trials.

The last of the three models (“Accelerating Clinical Evidence”) is of highest interest to rheumatologists, as the model would be mandatory for Part B providers who administer these medications. We do not have much more logistical detail at this stage, but CSRO will closely monitor subsequent regulatory activity to determine the impact on rheumatology patients and practices.

Overall, at this point, CSRO is cautiously relieved to see that the Innovation Center will not pursue another sweeping Part B drug model that would reduce provider reimbursement across the board.

CSRO is recruiting for a Fellow-at-Large to serve as a non-voting member of our Board of Directors for a one-year term beginning May 1.

This position provides a unique experience for a Fellow to engage with CSRO's Board members, who are rheumatologists from across the United States with years of varied career experiences, and to be a liaison to other fellows about the importance of advocacy in rheumatology. 

The application deadline is March 30. Interested or know someone who might be? Check out our website to learn more and apply.

New in 2023, the Coalition of State Rheumatology Organizations (CSRO) is hosting a virtual seminar series titled Business of Rheumatology to help support rheumatology practices in building and strengthening their business.

The first seminar will be held on March 23 and focus on the realities of in-office dispensing, including a discussion on the pros and cons of this practice. Hear from a panel with experience in managing this element of a practice’s business, as well as their thoughts on its viability for rheumatology.

Business of Rheumatology: In-Office Dispensing

Thursday, March 23

4pm PT / 5pm MT / 6pm CT / 7pm ET

Underwriting Support Provided By: United Rheumatology, a Specialty Networks Company

CSRO is at the forefront of state, federal, and payer policies working to grant access, affordability, and relief for the rheumatology community.

Our advocacy work is constantly evolving and expanding to achieve the mission of CSRO: ensuring access to the highest quality care for the management of rheumatologic and musculoskeletal disease.

View a full listing of CSRO's priority issues on our website, and click through to learn about what they are, how they impact you, and what CSRO is doing about them.

ICYMI: Opportunity For Action in Your State

The following states have active legislation that needs your support – make your voice heard today:

Colorado

Biomarker Testing Coverage

• Take Action: HB1110

Minnesota

White Bagging

• Take Action: SF482 & HF544

Missouri

White Bagging

• Take Action: SB26 & HB198

North Dakota

Accumulator Programs

• Take Action: HB1413

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.

Be sure to check out our interactive legislative map tool for additional details.

CALIFORNIA

Accumulators

• AB 874: Referred to Committee on Health. Hearing tentatively scheduled for 3/17/23

Rebate Pass Through

• SB 873: Introduced, referred to Rules committee

Biomarker Testing

• SB 496: Referred to Health committee

Gold Card

• SB 598: Referred to Health committee

COLORADO

Biomarker Testing

• HB 1110: Amended by House Health and Insurance committee and re-referred to Appropriation committee

Step Therapy

• HB 1183: Health and Insurance committee report do pass as amended, referred to appropriations

GEORGIA

Biomarker Testing

• HB 85: Transmitted to the Senate

Rebate Pass Through

• HB 343: Reported favorably by House committee, and re-referred to committee

FLORIDA

Accumulators

• HB 1063: Referred to Healthcare Regulation subcommittee

Non-medical Switching

• SB 746: Referred to Banking & Insurance, Appropriations, Agriculture, Environment and General Government, and Fiscal Policy committees

Biomarker Testing

• HB 805: Referred to Healthcare Regulation subcommittee 

ILLINOIS

Rebate Pass Through

• HB 1054: Assigned to Executive committee

White Bagging

• SB 1255: Postponed in Insurance committee
• HB 2814: Introduced and referred to Insurance committee

INDIANA

Rebate Pass Through

• SB 8: Approved by Senate, transmitted to House, referred to committee on Insurance

KENTUCKY

Gold Card

• HB 134: Amended by House Health Services committee and reported do pass, re-referred to Banking and Insurance committee

White Bagging

• SB 149: Referred to Banking and Insurance committee
• HB 350: Introduced and referred to Banking and Insurance committee

MINNESOTA

Biomarker Testing

• SF 1948: Referred to Commerce and Consumer Protection committee

Non-medical Switching

• HF 294: Committee recommends passage, re-referred to Judiciary, Finance and Civil Law committee

White Bagging

• HF 544: Re-referred to Health Finance and Policy

MISSOURI

Accumulators

• HB 442: Reported do pass by committee

MONTANA

Gold Card

• SB 380: Hearing held in Business, Labor and Economic Affairs committee on 2/28/23

NEVADA

Step Therapy

• SB 194: Introduced
• SB 167: Introduced and referred to Commerce and Labor committee 

NEW MEXICO

Accumulators

• SB 51: Recommended do pass, and referred to Tax, Business and Transportation committee
• SB 14: Referred to Tax, Business and Transportation and Judiciary committees 

Rebate Pass Through

• SB 14: Referred to Tax, Business and Transportation and Judiciary committees 

Biomarker Testing

• HB 73: Approved by House of Representatives, introduced and referred to Senate committee

NORTH DAKOTA

Accumulators

• HB 1413: Referred to House Human Services committee

Non-medical Switching & Prior Authorization

• SB 2389: Approved by Senate, transmitted to the House

White Bagging

• SB 2378: Approved by Senate, Introduced in House, referred to Human Services committee

OKLAHOMA

Biomarker Testing

• SB 513: Amended and reported do pass by committee

Rebate Pass Through

• HB 2853: Amended by committee and reported do pass

PENNSYLVANIA

Accumulators

• SB 372: Introduced and referred to Banking and Insurance

RHODE ISLAND

White Bagging

• H5680: Introduced and referred to Health and Human Services Committee

TEXAS

Non-medical Switching

• HB 826: Referred to Insurance committee 

UTAH

Accumulators

• SB 184: Held by House committee and returned to Rules committee

VIRGINIA

Rebate Pass Through

• HB 1782: Left in Committee on Commerce and Energy
• SB 1425: Left in committee on Commerce and Labor

WASHINGTON

White Bagging

• SB 5213: Approved by committee, passed to Rules committee for second reading

CSRO's Fellows Conference: March 10-11, 2023

An annual event curated by rheumatologists specifically for rheumatology fellows.

Business of Rheumatology: March 23, 3023

Learn about the realities of in-office dispensing at CSRO's new virtual seminar series to help support rheumatology practices in building and strengthening their business.

Regional Town Halls: Mondays in April & May

Hear advocacy updates specific to your area and network with your community members.

CSRO's Advocacy Conference: August 25-27, 2023

Join us in Austin for our Advocacy Conference and celebration of our 20th Anniversary! 

Action Center

Use CSRO's Voter-Voice engagement platform to easily communicate and engage directly with your elected officials.

Career Center

Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.

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.

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.