Category: ACR

The following is a press release issued by the ACR on August 22, 2023:

The American College of Rheumatology (ACR) released summaries of two new guidelines for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Disease and for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases (SARDs). The guideline summaries provide recommendations for screening, monitoring, and treating patients with rheumatic conditions like rheumatoid arthritis, systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIM) who may be at risk of interstitial lung disease (ILD) development or progression.

“Interstitial lung disease is a major cause of morbidity and mortality across several systemic autoimmune rheumatic diseases,” said Sindhu R. Johnson, MD, Ph.D., lead author on the guidelines and director of the University of Toronto’s clinical epidemiology & healthcare research program. “Guidance was needed for which tests to use for screening and monitoring this particular disease.”

A few recommendations from the guidelines include:

• A conditional recommendation to screen patients at high risk of ILD with HRCT chest, PFTs, or both
• A conditional recommendation to monitor ILD progression with PFTs and/or HRCT chest, albeit with different frequency.
• A conditional recommendation to monitor with ambulatory desaturation testing.
• A conditional recommendation against screening and monitoring with a 6-minute walk test distance (6MWD), chest radiography, and bronchoscopy.
• For people with SARD-ILD other than SSc-ILD, we conditionally recommend glucocorticoids as a short-term, first-line ILD treatment.
• A strong recommendation against glucocorticoids as a first-line ILD treatment for people with systemic sclerosis-associated ILD.
• A conditional recommendation for use of mycophenolate, rituximab, cyclophosphamide, and azathioprine as first-line ILD treatment options.
• A conditional recommendation against using leflunomide, methotrexate, TNF inhibitors, and abatacept as first-line ILD treatment options.
• For people with SARD-ILD progression despite first ILD treatment, it is conditionally recommended to use mycophenolate, rituximab, cyclophosphamide, and nintedanib as treatment options.
• For people with Sjogren’s-ILD and IIM-ILD progression despite first ILD treatment, a conditional recommendation against using tocilizumab as a treatment option.

“In those with systemic sclerosis-ILD, we strongly recommend against using glucocorticoids as a first-line ILD therapy or after ILD progression because glucocorticoids confer an increased risk of scleroderma renal crisis,” said Johnson. “Given the moderate certainty of the evidence for harm and low certainty of the evidence for benefit, we voted strongly against using this treatment for patients with systemic sclerosis-ILD.”

These new recommendations will provide guidance for clinicians on the screening, monitoring, and use of a wide range of treatments for patients with rheumatic diseases. The ACR developed these with the best available evidence and consensus across a range of expert opinions and incorporated patient values and preferences. These guidelines may reduce regional variation in patient care and may be used for patient advocacy.

“We know that early detection and hastened referral to care, in collaboration with pulmonology, is critical for the best patient outcomes,” said Sonye K. Danoff, MD, Ph.D., guideline author, pulmonologist and director of the Interstitial Lung Disease/ Pulmonary Fibrosis program at Johns Hopkins University School of Medicine. “Because symptoms of ILD (cough, shortness of breath, fatigue) can be subtle or result from other common diseases, the diagnosis of ILD can be delayed. Increasing awareness of the groups at highest risk for developing ILD and implementing appropriate screening and treatment practices should have long-term benefits.”

Full manuscripts have been submitted for journal peer review. Both are anticipated to be published in rheumatology journals by early 2024. View the complete summaries of the guideline recommendations at https://rheumatology.org/interstitial-lung-disease-guideline.

The following is a press release from ACR dated June 15, 2023:

The American College of Rheumatology (ACR) today expressed disappointment that the Medicare Payment Advisory Commission (MedPAC) has recommended yet another cut to physician reimbursement for infusing life-altering treatments as part of its June 2023 Report to the Congress: Medicare and the Health Care Delivery System.

In a letter to MedPAC, ACR took issue with the organization’s recommendation to Congress to keep a six percent add-on payment for the lowest-cost drugs, reduce the add-on payment for mid-to-high-level drugs, and add a payment cap for the costliest drugs.

“While we support efforts to rein in the cost of prescription drugs, we firmly believe that this policy would jeopardize provider practices and patients’ health by reducing access to life-changing provider-administered therapies,” said Douglas White, MD, PhD, president of the ACR. “We urge Congress to address the high cost of drugs at the root cause, like the opaque pharmacy benefit manager business practices, and not at the expense of providers.”

In its recommendation, MedPAC asserted that providers prescribe and administer the highest-price medications in order to receive higher reimbursement. ACR firmly rejects this premise. Administering Medicare Part B drugs in provider offices requires rheumatologists to buy the drug in bulk, maintain full-time staff to administer the treatment, and only bill Medicare after it has been given to the patient.

The six percent of the average sales price (ASP) add-on does not incentivize high-cost treatments, but rather offsets the costs of acquiring, storing, and administering treatments. As written, MedPAC’s recommendation would force providers to cut back on offering cutting-edge therapies or offer these medications at a loss, severely limiting patients’ access to medication and threatening practice viability.

“As providers, it is our job to prescribe the most appropriate treatment for our patients. The add-on payments are not considered in our clinical decision-making. We are concerned that policymakers are concentrating on these add-on payments rather than focusing on policies that address the true cause of drug prices,” said Christina Downey, MD, chair of ACR’s Government Affairs Committee. “The ACR will always express concern when provider payments to administer drugs are eschewed by widely supported policies. Hopefully, the bipartisan movement to reform the PBMs industry will yield meaningful change, and patients will see the benefits.”

The following is a press release issued by the ACR as of yesterday, April 24, 2023:

Today, the American College of Rheumatology (ACR) commended the introduction of the Strengthening Medicare for Patients and Providers Act (H.R. 2474), a bipartisan bill intended to update Medicare physician payments to reflect the impact of the broader economy on physician practices.

The legislation, introduced by Reps. Raul Ruiz, M.D. (D-CA), Larry Bucshon, M.D. (R-IN), Ami Bera, M.D. (D-CA), and Mariannette Miller-Meeks, M.D. (R-IA), would adjust the Medicare Physician Fee Schedule (MPFS) based on inflationary updates measured by the Medicare Economic Index (MEI).

“For too long, specialty providers, like rheumatologists, have faced considerable uncertainty regarding their ability to continue providing needed care to patients,” said Douglas White, MD, PhD, president of the American College of Rheumatology. “The Strengthening Medicare for Patients and Providers Act represents a long-overdue adjustment to the Medicare Physician Fee Schedule that will help stabilize physician practices and ensure that beneficiaries have timely access to rheumatological care.”

The MPFS is the only major fee schedule without an automatic inflationary update. Consequently, Medicare provider reimbursement has failed to keep pace with broader economic realities. Recent analysis from the American Medical Association (AMA) demonstrates that when adjusted for inflation, Medicare physician payments declined 26% from 2001 to 2023, as consumer and practice costs rose.

“This legislation would allow Medicare to more accurately reflect the cost of practicing medicine, which has increased dramatically in recent years,” said Christina Downey, MD, chair of ACR’s Government Affairs Committee. “ACR looks forward to working to advance this important policy reform that will help build a sustainable payment system and protect access to care for patients with serious, chronic diseases.”

The following is a press release issued by the American College of Rheumatology dated January 31, 2023:

The American College of Rheumatology (ACR) today submitted comments to Centers for Medicare and Medicaid Services (CMS) administrator Chiquita Brooks-LaSure urging the agency to reconsider its current policies on essential copay assistance programs that enable patient access to needed treatments.

Current CMS policy allows insurers to exclude copay assistance from counting toward a patient’s deductible. Copay assistance programs provide patients with financial relief from the high costs associated with many treatments, such as biologics and biosimilar products, upon which they rely to control rheumatic diseases. Without copay assistance, many patients will be unable to pay their deductible, resulting in delays to needed treatment, medication rationing, or forfeiting treatment entirely.

“Rheumatologists care for patients with complex chronic and acute conditions that often require costly treatments. Without vital programs like copay assistance to help them afford treatment, our patients can face irreversible joint and tissue damage as well as serious declines in the quality of their everyday lives,” said Douglas White, MD, PhD, President of the ACR.

The ACR remains deeply concerned about cost-shifting tactics used by health insurers that place a disproportionate financial burden on patients with chronic rheumatic and musculoskeletal conditions like lupus and rheumatoid arthritis. With roughly 95% of expensive specialty medicines having no generic or lower-cost alternative, this proposed rule will leave many rheumatology patients in an untenable position.

“The ACR is deeply concerned that the proposed policies to increase the maximum out-of-pocket limitations, coupled with allowing insurers to exclude copay coupons to be applied toward a patient’s out-of-pocket limit, debilitates our patient’s ability to access the treatments needed to help manage their painful chronic condition,” wrote ACR in its letter. “While we understand the need to find solutions to help curb the increasing cost of healthcare, we cannot support policies that sacrifice our patients’ health in the name of cost savings.”

The following is a press release issued by ACR this morning (Nov 2, 2022).

The American College of Rheumatology (ACR) has released Continuing Medical Education (CME) for dermatologists and nephrologists to help them learn more about clinical trials for lupus patients in their respective treatment areas and the importance of getting more of their African American/Black patients enrolled.

Lupus is a multisystem disease and is frequently managed by a care team including rheumatologists, nephrologists, dermatologists, and other specialists. African American/Black, Hispanics and Native Americans are also disproportionately affected by the condition. This new CME is part of the ACR’s “Materials to Increase Minority Involvement in Clinical Trials” (MIMICT) initiative and is aimed at educating these providers on the importance of increasing minority participation in lupus clinical trials.

“In the United States, African American/Black patients represent approximately 43 percent of lupus cases, however, only 14 percent of lupus clinical trial participants are African American/Black,” said Starla H. Blanks, Senior Director of Collaborative Initiatives for the American College of Rheumatology. “African American/Black patients with lupus. They are also four times more likely to get lupus nephritis, a type of kidney disease, which can increase the mortality rate.”

The new CME provides nephrologists and dermatologists with specific information on racial disparities in lupus clinical trials, why it’s important to increase minority participation in lupus clinical trials, and the barriers providers face when encouraging patients to participate in lupus clinical trials.

“Skin and kidney symptoms are common in lupus patients and there are clinical trials specifically targeting these two organ systems. The CME training addresses barriers like patient mistrust, lack of familiarity with trials, and an intimidating consent process,” said Rosalind Ramsey-Goldman, MD, DrPH, chair of the ACR’s Collaborative Initiatives Committee. “It also addresses facilitators like culturally sensitive communication and social support by emphasizing skills that provide support for both the provider and the patient.”

The new CME for nephrologists and dermatologists can be found on the ACR’s Lupus Initiative website. The expansion of MIMICT was made possible by a two-year grant for the ACR’s Training to Increase Minority Enrollment in Lupus Clinical Trials with CommunitY Engagement (TIMELY) project from the U.S. Department of Health and Human Services Office of Minority Health. More information about the ACR’s work on lupus awareness and educational programs can be found at www.thelupusinitiative.org.