Our Issues
The 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 focuses on educating members of Congress and state legislatures to achieve the mission of the CSRO: ensuring access to the highest quality care for the management of rheumatologic and musculoskeletal disease.
CSRO State Priority Issues:
- Accumulator Adjustment, Alternative Funding & Maximizer Programs – Co-pay assistance is the only means many patients have to afford medically necessary medications. New policies being implemented by PBMs and plans are threatening co-pay assistance programs, and patients’ ability to afford their medically necessary treatments. CSRO supports legislation that prohibits the use of these programs.
- Biomarker Testing – Rapid innovation is occurring for biomarker testing in the rheumatology space. CSRO is working to ensure these tools are accessible for rheumatologists to utilize in their practice.
- Drug Affordability Boards – Policymakers are considering the use of drug affordability boards and other pricing reform mechanisms to control the cost of prescription drugs. These policies have the potential to disrupt access to provider administered drugs, and CSRO is working to minimize the disruptive potential of these policies.
- Drug Supply Chain and Pricing Reform – The CSRO is actively working to reform and regulate the harmful practices of pharmacy benefit managers (PBMs), which are located at the center of the drug supply chain model.
- Non-Medical Switching – CSRO supports protecting currently-stable patients from switching medications for non-medical reasons within a plan year. We work with the KeepMyRx Coalition in supporting non-medical switching legislation.
- Prior Authorization/Gold Carding – This administrative burden distracts from the provision of high-quality care and costs health systems close to a billion dollars annually. CSRO lends its voice to conversations regarding ways to reduce the administrative burden.
- Specialty Pharmacy Mandates – Many rheumatology practices currently use the “buy and bill” method of acquisition for provider-administered drugs. Payers have begun to challenge this process through mandates such as “white-bagging,” which CSRO actively campaigns against.
- Step Therapy/Fail First – through our leadership in the State Access to Innovative Medicine (SAIM) Coalition, CSRO leads on-the-ground coalition work in target states.
CSRO has been at the forefront of some of the greatest policy advances for rheumatology providers and their patients. Through the active participation of CSRO leadership, member organizations, and the broader community, we make advocacy work:
- The CSRO facilitated the creation of both the National Organization of Rheumatology Managers (NORM) and the Alliance of Transparent and Affordable Prescriptions (ATAP). These two pivotal organizations have amplified the rheumatology voice with payers, CMS, and state lawmakers across the country.
- Step Therapy/Fail First state policies have been key to helping patients override unnecessary protocols to access the medication that would work best for them in a timely manner. Through our work with the State Access to Innovative Medicine (SAIM) Coalition, over half of the states have passed legislation granting improved access for patients. CSRO is the current Chair of the organization and has taken leadership roles in heading state coalition activities for identified state targets.
- Payer policy revisions and mandates have increased exponentially in the last five years. CSRO has been successful in helping overturn non-medical switching practices and protecting current patients by having them grandfathered into the original coverage policy. These payer issues also include reimbursement changes in coding and changes to acquisition models that have a significant impact on our providers.
- CSRO leadership participates in numerous Hill meetings throughout the year, which includes a federal fly-in that is hosted by the CSRO for leadership and advocates from our member organizations. Federal meetings are also held with CMS and individual MACs to discuss ongoing issues impacting the practice of rheumatology.
CSRO Federal Priority Issues:
- Safe Step Act
- Improving Seniors’ Timely Access to Care Act
- HELP Copays Act
- PBM Reform
- Part B Drug Reimbursement
- Medicare Physician Payment and Physician Fee Schedule
- Quality Payment Program (QPP)
- MIPS Value Pathways (MVP)
- Medicare Advantage (MA), Part D, and Exchange Plan Reforms
CSRO Advocacy Resources:
