CSRO's Executive Committee met with 11 congressional offices – including those of Speaker Johnson, Leader Scalise, Sen. Cassidy, and Rep. Pallone – during a November 18 visit to Capitol Hill. Drs. Gary Feldman, Madelaine Feldman, Aaron Broadwell, and Michael Saitta were joined by Dr. Firas Kassab, Dr. Elnaz Balashi, and CSRO Executive Director Leslie Del Ponte to discuss Lame Duck priorities with these prominent offices. ‘Lame Duck’ refers to the period after the November 5 elections and before the 119th Congress is sworn into office on January 3, 2025. During this time, Congress will meet to wrap up urgent or unfinished business.

During their congressional meetings, CSRO leaders spoke to members about the need to address:

• The impending 2.8% cut to the Medicare Physician Fee Schedule before its January 1, 2025, start date;
• Pharmacy Benefit Manager (PBM) reform and incorporate delinking and rebate pass through within any end-of-year package; and
• The “underwater” biosimilar crisis that is hurting physicians and limiting patient access to biosimilar medications

To learn, click here to review the issue briefs. To engage your members of Congres, visit the CSRO Action Center.

In a letter to Majority Leader Schumer (D-NY) and Minority Leader McConnell (R-KY), 41 bipartisan Senators urged leadership to address the 2.8% cut to the Medicare Physician Fee Schedule, which is set to go into effect on January 1, 2025. Within the letter, members of Congress stated, “Persistent instability in the health care sector – due, in part, to consistent payment cuts – impacts the ability of physicians and clinicians to provide the highest quality of care… These continued payment cuts undermine the ability of independent clinical practices – especially in rural and underserved areas – to care for their communities.”

While the impending cut was the priority focus, the letter also highlighted the need for long-term legislative solutions to the Fee Schedule, including statutory budget neutrality requirements and payment updates reflective of inflation.  

CSRO also submitted a letter to congressional leadership urging them to take action before the January 1, 2025, cut. 

Support PBM Reform

CSRO supports several PBM reform measures that incorporate two key policy principles: delinking a drug's price from PBM revenue and requiring PBMs to pass through discounts and rebates directly to patients. As the 118th Congress comes to a close, it’s critical that members hears from constituents on the importance of including these two foundational policies in any year-end package that may advance.

Contact your members of Congress today!

Stop the Impending 2.8% MPFS Cut

On January 1, 2025, CMS will reduce Medicare reimbursement for physician services by 2.8%. If this cut goes into effect, physicians will face a total 6.4% cut due to the additional CMS estimated increase in practice expenses for 2025 at 3.6%.

Congress has the ability to stop the 2.8% cut, and it’s crucial they take action before the new year.

Contact your members of Congress now!

Patients can currently enroll in two new benefits in Part D – a $2,000 limit on annual Part D out-of-pocket prescription drug costs and spreading out the cost of their Part D out-of-pocket costs throughout the year. Both programs will go into effect January 1, 2025, and can be helpful for patients with high out-of-pocket drug costs, preventing medication abandonment and treatment delays.

Resources that can be used by rheumatology practices to better understand the impact of these programs on patient access to Part D medications are linked below, including a handout that can be given directly to patients who are interested in enrolling in these benefits at no additional cost.

Both programs are for Medicare enrollees through their Part D or Medicare Advantage plan. Patients can enroll at any time and are not restricted to open enrollment periods to receive these benefits.

CSRO is a proud member of Let My Doctors Decide (LMDD), a national partnership in support of policies that ensure treatment decisions are made by patients and their health care professionals, not insurance companies or pharmacy benefit managers. LMDD is looking to hear from patients and providers about their experiences with Medicare - share your story today!

NJ: Meet with Your State Officials on Step Therapy

CSRO, state rheumatology societies and the State Access to Innovative Medicines (SAIM) Coalition have passed step therapy reform laws across the country. This year, CSRO is working with advocates in New Jersey to advance step therapy patient protections. This December, the Coalition is organizing meetings with New Jersey state legislators to showcase the importance of these reforms. The Coalition is looking for rheumatologists and their practice partners to participate and discuss the impact step therapy has on your practice and patients.

If you are interested in meeting with your state legislators, sign up here. 

OR: Gewanter Testified before PDAB

On November 20, Harry Gewanter, MD, FAAP, MACR testified before the Oregon Prescription Drug Affordability Board and expressed concerns regarding the Upper Payment Limit (UPL) included within the Senate File 192 draft report. Dr. Gewanter highlighted the impact the UPL will have on provider administered medications and patient access to those drugs. He also asked the Board to address their lack of physician review of the considered medications. CSRO will continue to engage the PDAB and advocate for protections that ensure access to rheumatologic medications.  

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients. Click here to view a full status report of CSRO priority bills.

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

Business of Rheumatology: December 4, 2024

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

CSRO Fellows Conference: February 21-23, 2025

An annual event to help rheumatology fellows prepare for their future roles as practicing rheumatologists.

SAVE THE DATE - CSRO Advocacy Conference: September 12-14, 2025

Mark your calendars to join us in Dallas, Texas, for CSRO's annual Advocacy 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 Rheumatology News.

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.