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 from the ACR dated 12-21-2022:

The American College of Rheumatology is pleased to announce another successful recruitment season and welcomes this impressive pool of applicants to the field of rheumatology. 75 percent of the eligible candidates interested in adult rheumatology and 96 percent of eligible applicants interested in pediatric rheumatology were matched to fellowship programs for the 2023 appointment year as part of the annual National Residents Matching Program (NRMP).

Rheumatology leaders again noticed a stark contrast when looking at the percentage of available adult and pediatric fellowship slots that were filled. Whereas the adult programs filled 97.8 percent of their available slots, the pediatric programs only filled 62.8 percent, signaling a need to increase interest in pediatric rheumatology. While the number of adult fellowship matches has seen a steady increase over the past five years, interest from candidates has continued to exceed the number of available positions, suggesting ongoing opportunity to expand fellowship training opportunities. Continuing to make progress in these areas will be important given the workforce shortage projections identified in ACR’s 2015 workforce study.

“This year was the first time that the adult and pediatric fellowship Match dates aligned, allowing participants the opportunity to apply to and rank both adult and pediatric training programs in a single rank list by a dual-trained applicant or by a couple. This change has been welcome, as it facilitates the application process for a number of candidates,” said Beth Marston, MD, chair of the American College of Rheumatology’s (ACR) Committee on Training and Workforce Issues (COTW).

“Unfortunately, we continue to see limited numbers of applications for pediatric rheumatology fellowship positions, with 27 applicants filling only 26 of a possible 43 total positions. Other pediatric specialties such as pediatric pulmonology, nephrology, infectious disease, and endocrinology also had a significant number of unfilled positions; in contrast, the relatively new field of pediatric hospital medicine filled nearly all open positions, which may hint at the goals and training interests of current pediatric applicants. Many potential barriers have been suggested, including inadequate exposure and mentorship within these specialties, long periods of required training, and lower ultimate compensation for pediatric specialists, which might be targets for future work to improve our pediatric specialty workforce,” continued Marston.

“The adult rheumatology workforce also remains threatened, with ongoing national efforts by the ACR’s Workforce Solutions Committee to increase fellowships and fellowship positions, particularly in geographically underserved areas. Because a substantial number of applicants have remained unmatched over the last several years, any increase in the number of available fellowship positions is likely to continue to directly affect the future physician workforce within rheumatology,” Marston concluded.

In addition to efforts to continue to increase fellowship positions, the ACR continues to work to create new mechanisms to increase exposure to rheumatology earlier in training, to understand barriers to training in pediatric and combined internal medicine and pediatrics rheumatology, and to support programs and program directors as they navigate curricular and regulatory changes.

The NRMP, established in 1952 at the request of medical students, uses a computerized, mathematical algorithm to align the preferences of applicants and program directors to fill training positions available at teaching hospitals in the United States. Full details of the 2022 Match Day results for adult and pediatric fellowships can be found online here.

The following is a press release from this past week, care of the ACR.

The American College of Rheumatology (ACR) released a summary of its updated guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Many patients take glucocorticoids for a variety of inflammatory conditions, and anyone who is taking glucocorticoid medications and has other risk factors for osteoporosis increases their risk of developing glucocorticoid-induced osteoporosis. New osteoporosis medications and new literature have become available since the last ACR treatment guideline was published in 2017.

“One major side effect of glucocorticoid therapy is bone loss and an increase in the risk of fractures. Fractures can cause significant morbidity and be associated with an increased risk of mortality,” said Mary Beth Humphrey, MD, PhD, co-principal investigator of the guideline and interim Vice President for Research and a Professor of Medicine at the University of Oklahoma Health Sciences Center. “With newly approved osteoporosis medications and a review of the relevant literature, we felt it was important to update the guideline.”

The guideline team conducted an updated systematic literature review for clinical questions on non-pharmacologic and pharmacologic treatment addressed in the 2017 guideline, and for questions on new pharmacologic treatments, discontinuation of medications, sequential and combination therapy.  The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A Voting panel including clinicians and patients achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

The guideline includes recommendations on abaloparatide and romosozumab, which are two medications that are newly available since the 2017 guideline, as well as recommendations for other osteoporosis medications.

The guideline also recommends sequential therapy (any treatment regimen in which the patient is given one treatment followed by another), which was not addressed in the previous guideline. The recommendations for sequential therapies are based in part on some study designs, long term follow-up studies, and new clinical trials.

“Some physicians may be surprised about the need for sequential therapy when completing a course of denosumab, parathyroid hormone/parathyroid hormone related protein, or romosozumab. If not done, patients could be at risk of rapidly developing vertebral fractures and bone loss,” said Linda Russell, MD, Director of Perioperative Medicine, Director of the Osteoporosis and Metabolic Bone Health Center for the Hospital for Special Surgery and co-principal investigator of the guideline.

The updated guideline also gives more flexibility on drug selection and considers patient and physician preferences.

“The previous guideline rank-ordered medication for the treatment of glucocorticoid induced osteoporosis. We felt it was important that this guideline reflect patient/physician decision making,” said Dr. Humphrey.

A full manuscript has been submitted for journal peer review and is anticipated to be published in rheumatology journals in early 2023. The summary of the guideline recommendations can be viewed in full on the ACR website.