July 2, 2026

This issue highlights the latest developments affecting rheumatology, including new clinical guidelines, advocacy priorities, Medicare payment updates, federal research policy, and emerging opportunities to leverage RISE registry data. Explore the stories shaping rheumatology practice, research, and patient care below.

New Guidelines Advance Axial Spondyloarthritis Care Across the Lifespan

The ACR has released new and updated clinical guidelines for axial spondyloarthritis (axSpA), offering aligned, evidence-based recommendations for both adults and children. The effort updates the 2019 ACR/SAA/SPARTAN adult guidelines and introduces the first dedicated juvenile axSpA guideline, emphasizing personalized care and shared decision-making amid ongoing evidence gaps.

Key Diagnostic and Treatment Updates

For adults, sacroiliac joint X-rays remain the preferred initial imaging, followed by MRI as needed, while in children and adolescents, MRI of the sacroiliac joints without contrast is recommended as the primary modality. Once axSpA is confirmed, NSAIDs are first-line; for patients at higher risk of progression or with inadequate response, TNF inhibitors or IL-17 inhibitors are equally recommended as initial biologic DMARDs, with JAK inhibitors reserved for later lines.

Conventional synthetic DMARDs are generally discouraged for axial disease unless peripheral arthritis or extra-musculoskeletal manifestations (EMMs) such as uveitis, inflammatory bowel disease, or psoriasis are present. EMMs guide targeted therapy choice (monoclonal antibody TNFi for uveitis/IBD; IL-17 inhibitors for psoriasis), and in well-controlled disease, gradual dose reduction may be considered while avoiding abrupt treatment discontinuation to prevent flares.

The new pediatric guideline addresses differences in disease biology, risk, and long-term considerations in youth, supporting earlier diagnosis, appropriate imaging, and tailored therapy across the lifespan.

ACR Endorsed Prior Authorization Bill Passes Key Committee Vote

Great news! Last week, the House Energy and Commerce Subcommittee on Health passed the Improving Seniors Timely Access to Care Act (H.R. 3514) by voice vote, clearing the way for a full committee markup. Representatives John Joyce MD (R-PA), Kim Schrier MD (D-WA), Mariannette Miller-Meeks MD (R-IA), Lizzie Fletcher (D-TX), and Troy Carter (D-LA) all spoke in strong support of the bill. The ACR has supported this legislation for several Congresses, and we are glad to see it clear this key procedural hurdle.

This bipartisan legislation would introduce several reforms into the prior authorization process in Medicare Advantage plans. With nearly 33 million Americans enrolled in Medicare Advantage, this bill updates a system that has become a top administrative burden for providers and a barrier to patient’s access to care. Audits by the Department of Health and Human Services Inspector General have found that Medicare Advantage plans subjected enrollees to unnecessary delays, denied medically necessary care without clinical backing, and ultimately approved 75% of requests that were initially denied.

Use the ACR’s Legislative Action Center to add your voice to the conversation. Ask your member of Congress today to support the Improving Seniors to Timely Access to Care Act to make Medicare Advantage function better for rheumatologists and their patients!

CMS Narrows Medicare Payments for Orencia, Tightening Margins for Rheumatology Practices

The Centers for Medicare and Medicaid Services (CMS) has implemented a change to how Medicare Part B pays for the office administered formulation of Orencia (abatacept), resulting in lower reimbursement for rheumatology practices that buy and bill the drug through their infusion suites. This policy stems from congressional direction and Health and Human Services (HHS) oversight aimed at closing a “payment loophole” created when self administered versions of certain drugs—including Orencia—were included in Part B payment calculations, even though they are not covered under Part B.

For rheumatologists, the shift means tighter financial margins on Orencia infusions, the need to reassess drug acquisition contracts and infusion center budgets, and more careful consideration of whether patients receive IV versus self administered formulations under different benefit structures. Practices will need close coordination between clinicians, administrators, and billing teams to monitor reimbursement, maintain sustainable infusion services, and communicate clearly with patients about any changes in site of care or regimen that may result from this CMS ruling.

We encourage practices and providers to reach out to us directly with any questions, support needs, or to discuss reimbursement challenges and denials related to these changes at practice@rheumatology.org.

As we continue gathering information and working to better understand the impact of this CMS ruling, input from practices will be invaluable. We are here to help navigate these changes together and to advocate on behalf of the rheumatology community.

OSTP “Nelson Memo” Repeal May Impact Rheumatology Research Publishing

In August 2022, the Biden Administration’s Office of Science and Technology Policy (OSTP) issued a policy known as the “Nelson memo,” directing federal agencies to make federally funded research immediately publicly available by the end of 2025, without embargo. The policy also allowed investigators to include publication and data management costs—such as article processing charges—in federal grant budgets.

Recent developments signal a shift in federal policy that could affect rheumatology researchers. Proposed rulemaking from the Trump Administration (June 2026) would prohibit the use of federal grant funds for publication costs unless explicitly authorized in the original award. This change, along with broader concerns from Congress and federal agencies about the rising cost of open-access publishing, has placed the future of the Nelson memo in question. A 2024 Government Accountability Office analysis estimated that federal open-access publishing costs could approach $937 million annually by 2030.

OSTP is now reportedly in the process of repealing the Nelson memo, though formal guidance has not yet been issued. Congressional appropriators have acknowledged the repeal effort and directed agencies, including the National Science Foundation, to pause implementation of new public access policies tied to the memo. OSTP is expected to provide an update to Congress within 30 days of the appropriations bill’s enactment.

For rheumatology researchers, these policy changes could have implications for how federally funded studies are published, including potential limitations on covering publication fees and shifts in public access requirements.

AMA House of Delegates Approves Major Directives on AI, PBMs, Research Funding Cuts, and More

The American Medical Association (AMA) held its annual House of Delegates (HOD) meeting from June 5 through 10. The HOD discussed and adopted resolutions on many ACR advocacy priorities, including:

• Pharmacy benefit manager (PBM) regulation: The HOD adopted several resolutions recommending greater regulation of PBMs, including one (co-sponsored by the ACR delegation) that would mandate that when an insurer or PBM undergoes structural changes, they must honor a patient’s existing care plan for a minimum of 90 days to prevent non-medical switching. Another resolution would prevent PBMs from owning or operating pharmacies.
• Physician workforce: The HOD took up a resolution opposing recent Department of Education policy imposing a cap on federal student loans and another resolution advocating for the creation of an expedited visa pathway specifically for foreign physicians.
• Research: A resolution opposing recent Office of Management and Budget guidance that would drastically increase political oversight of federal funding decisions, including NIH grant awards, was adopted, as was another resolution opposing any kind of reorganization or OMB interference at the NIH implemented without consulting biomedical and physician communities.
• Copay accumulator adjustment programs: The HOD adopted a resolution directing the AMA to oppose the practice of excluding manufacturer discount payments from a patient’s deductible or out-of-pocket spending limit. This practice (called “copay accumulator adjustment”) is used by many PBMs and insurance plans and can result in higher costs for patients.
• Osteoporosis screening and musculoskeletal health: Two resolutions specific to musculoskeletal health were adopted, one that would require the AMA to advocate for increased coverage of osteoporosis screening and therapies and another that affirms AMA support of nationwide public and physician education initiatives aimed at increasing awareness of osteoporosis risk factors and prevention.

The HOD also took up a resolution pressing for safeguards in use of ‘augmented’ intelligence by payers in making adverse coverage determinations, opposing legislation that auto-enrolls patients into Medicare Advantage (requiring them to opt in to traditional Medicare) and reaffirming opposition to cuts to Medicaid in HR 1.

Amanda Myers, chair of the ACR’s Government Affairs Committee and a first-time attendee at the meeting, said, “I was impressed with how thoroughly the AMA addresses issues affecting rheumatology, and surprised that the ACR has only two of the 350 apportioned delegates. We must increase ACR membership in the AMA to amplify the voices of our specialty and our patients."

Rheumatologists play a critical role in AMA membership because their participation ensures that the specialty has a strong, credible voice in national decisions that directly affect rheumatology practice and patient care. When enough ACR members also belong to the AMA, rheumatology maintains representation in the AMA House of Delegates, CPT and RUC committees, and key advocacy coalitions—venues where policies on reimbursement, coding, scope of practice, and access to therapies are made.

Take action now!

Join or renew your AMA membership →

RISE Registry Webinar to Highlight How Tokenized Data Linkages Reveal the Full Rheumatology Patient Journey

Join Jeffrey Curtis, MD, MPH, for an in-depth webinar on how the ACR’s RISE registry is opening up new possibilities for rheumatology research through tokenization and advanced data linkages.

On Friday, August 21, Dr. Curtis will walk through how de-identified data tokens can securely connect information across multiple healthcare data sources, giving investigators a much more complete picture of the patient journey—without compromising privacy. By linking data beyond routine rheumatology encounters, researchers can:

• Follow patients across specialist visits and primary care
• Capture hospitalizations and acute events that may not appear in clinic data
• Assess medication adherence and persistence over time
• Examine downstream outcomes and real-world effectiveness in greater detail

This expanded view can help answer questions that traditional clinical data alone cannot, support more robust observational studies, and generate insights that better reflect the realities of rheumatology care.

Register now to explore how tokenized, linked data from RISE can strengthen your research and inform future practice and policy decisions in rheumatology.

Disclosures: Jeffrey Curtis, MD, MPH

Honorarium / Consulting
AbbVie, Amgen, AQTUAL, BMS, GSK, Janssen, Lilly, Novartis, Pfizer, Sanofi, Scipher, Sensimetrica, SetPoint, UCB

Research Grants
AbbVie, Amgen, AQTUAL, Boehringer Ingelheim, BMS, GSK, Janssen, Lilly, Novartis, Pfizer, Sanofi, Scipher, SetPoint, UCB