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PBMs and New Approaches to Drug Pricing in 2019

Without a doubt, lowering list-prices for prescription drugs was a national focus in 2018. Coupled with numerous advocacy organizations bringing increased awareness to Pharmacy Benefit Managers’ (PBMs) unfair practices, and their effect on drug prices, several reforms have sparked across the U.S. and are expected to increase in intensity in 2019.

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CSRO Policy Update, January 2019, Issue 8

As the new year begins, I would like to reflect on the tremendous organizational successes that CSRO achieved in 2018. Over the past couple of years, CSRO made a commitment to deepening its ties with the societies it represents, and its allied patient and provider organizations. This year CSRO traveled to 20 state society meetings to bring increased awareness to the issues impacting practicing rheumatologists and patients in the U.S.

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CSRO Submits IPI Comments

Prior to commenting on the proposed International Pricing Index Model (IPI) for Part B drugs, CSRO leadership met with Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to convey rheumatology's perspective.

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CSRO Talks Accumulator Adjustment Programs at CBI Summit

Accumulator Adjustment Programs have become an increasingly prevalent issue since CSRO was first made aware of them in late 2017. Since then, the programs have been progressively crossing over from the employer to commercial space.

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Hospitals Beginning To Practice Non-Medical Switching

CSRO has been fielding reports from physicians around the states who have found that their patients are no longer able to access their prescribed treatment. Some hospital systems are no longer carrying biologic originator products, meaning that patients must find an alternative site of care.

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Express Scripts Announces New Formulary Design Option

This week, Express Scripts announced that it would provide clients with the ability to opt for its new National Preferred Flex Formulary Design. As opposed to favoring drugs that garner the most rebate dollars, the new benefit design intends to favor drugs that have lower list prices to begin with.

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CSRO Hosts State Society Leaders at the ACR

On Monday, October 22nd, CSRO hosted a breakfast for state rheumatology society leaders present at the ACR. Attendees had the opportunity to learn more about emergent patient access issues, CSRO’s plans for 2019, and hear from a speaker who discussed implementation and compliance issues with existing patient access laws.

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CSRO Discusses New Drug Payment Model with Key Agency Officials

Last week, CSRO’s Past President and National Advocacy Chair, Michael Schweitz, MD, participated in one-on-one discussions with Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma and Special Advisor to the Administrator Jeet Guram, MD, to discuss details about the Trump Administration’s potential International Pricing Index Model for Medicare Part B Drugs.

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New Data Emerges on Co-Pay Accumulator Programs

The CSRO has been deeply concerned about the expanded implementation of a new utilization management tool known as co-pay accumulator programs over the course of 2018.

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Annual State Society Advocacy Conference a Success

The CSRO was excited to host many members of the state rheumatology societies and other partners in Chicago on Saturday, September 15th for the annual State Society Advocacy Conference (SSAC).

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