July 30, 2026

This issue highlights opportunities to engage elected officials, recent advocacy wins, and ongoing efforts to address restrictive payer policies. It also includes important updates on the Tyenne supply shortage, Medicare payment policy, medication safety, and an upcoming RISE registry webinar.

Congress is Home – Engage your Elected Officials This August!

Each August, lawmakers head back to their states and districts to connect with their constituents. This means that you will have a prime opportunity to connect with your lawmakers and their staff next month. Keep reading for tips on engaging with your lawmaker while they are home for August Recess. Don’t forget! The ACR’s Legislative Action Center is always available for you to let your lawmakers know what policies matter to the rheumatology community.

Please reach out to the ACR’s Government Affairs team at advocacy@rheumatology.org with any questions or concerns.

Schedule an in-district meeting

• Request the meeting through your lawmaker’s scheduling portal a few weeks in advance. Use the U.S. House Find Your Representative tool using your zipcode and enter your full address on the Congress.gov Find Your Member page, to find your local lawmakers.
• Have a clear ask for your lawmaker and their staff. Contact the ACR’s Government Affairs team if you are having trouble tailoring your request.
• Be polite and clear in your request. Do you want the representative to co-sponsor legislation or champion a bill’s introduction?
• Follow up with a thank-you and any additional information requested.

Attend an in-person or telephone town hall

• Be on time and bring your colleagues!
• Prepare a concise question and remain calm and composed.
• Engage with staff and follow up with a thank-you.

Attend an in-district fundraiser with RheumPAC support

• Interested in supporting your lawmaker’s re-election campaign? Contact rheumpac@rheumatology.org to learn more about how RheumPAC can help.

Invite your lawmaker to visit your practice

• If you are interested in setting up a site visit for your member of Congress, please contact advocacy@rheumatology.org.

Key Wins on Prior Authorization, Momentum Builds for Payment Reform

On July 21, the House passed a continuing resolution (CR) that would fund the government through December 4 at previously authorized levels. It is important to note that telehealth flexibilities under Medicare are not impacted by this process, as Congress has extended those flexibilities through 2027. The Senate is expected to draft their own spending package rather than consider the House legislation.

Momentum on Prior Authorization Reform

The ACR applauds the House Energy and Commerce for unanimously passing the Improving Seniors' Timely Access to Care Act (H.R. 3514 / S. 1816) during a recent committee markup.

With this action, this key legislation has now cleared both of its House committees of jurisdiction. The bill passed the House Committee on Ways and Means by unanimous 42-0 vote earlier this month, following the bill’s approval by the Subcommittee on Health for the House Energy and Commerce at the end of June. This steady progress through committee reflects an extraordinary level of consensus behind a proposal that would improve patient care at no cost to taxpayers.

With both committees now behind the bill, the ACR urges House leadership to bring this bill to the floor for passage to improve access to care for the millions of seniors, veterans, and individuals with disabilities who have chosen MA coverage. Take action from home today and urge your lawmakers to support this legislation today!

Medicare Physician Payment Reform

A bipartisan group of lawmakers has introduced the Patients First Act (H.R. 9693), the first Medicare physician payment reform package jointly endorsed by the Republican and Democratic Doctors’ Caucuses. Additionally, we were glad to participate in a deliberative process and were pleased that ACR feedback was solicited and incorporated into the legislation.

The ACR has long urged Congress to work towards long-term, sustainable reforms to Medicare physician reimbursement to protect patient access to care, and we strongly support this landmark legislation. The Patients First Act (H.R. 9693), led by Representatives John Joyce, MD (R-PA), Kim Schrier, MD (D-WA), and Greg Murphy, MD (R-NC), would promote reimbursement stability and protect physicians by:

• Establishing inflation-linked payment updates in the MPFS
• Setting MPFS payment parameters to create payment predictability
• Raising the budget neutrality threshold that triggers payment offsets
• Making important changes to MIPS

Congress must act to pass policy changes that will address the impact of inflation and budget neutrality requirements on patients’ access to care. America’s physicians and patients deserve better – please contact your members of Congress today and urge them to co-sponsor H.R. 9693!

ISC Challenges Restrictive Payer Policies, Turning Your Concerns into Our Action

The ACR Insurance Subcommittee (ISC) has been hard at work this summer addressing payer policies that impact rheumatology practices and patient access to care. From challenging restrictive step therapy requirements to investigating downcoding and reimbursement issues, the committee continues to elevate the concerns being seen in practices across the country.

Fighting for Better Patient Access

One of the committee's primary areas of focus has been ensuring patients can access the medications and treatments their physicians determine are most appropriate. Over the past several meetings, ISC has reviewed and supported advocacy letters addressing restrictive payer policies, which require patients to fail multiple therapies before gaining access to recommended treatments, creating unnecessary delays in care.

Most recently, ISC reviewed concerns regarding policies requiring patients with very high fracture risk to fail both oral bisphosphonates and Reclast before accessing anabolic therapies. To help providers navigate similar situations in the future, the committee is also developing a template advocacy letter that can be customized for individual patients.

Addressing the Growing Impact of Biosimilar Switching

ISC continues to hear reports of treatment disruptions related to payer- and specialty pharmacy-driven biosimilar switching. Practices have reported medication shortages, repeated forced switches, and significant increases in patient out-of-pocket costs, which have resulted in delays in treatment. Committee members agree this remains a significant concern and are working with other rheumatology advocacy groups to explore broader solutions.

Pushing Back on Administrative Burden

The committee has also spent considerable time evaluating payer practices that create additional administrative challenges for rheumatologists. Ongoing discussions have focused on reports of evaluation and management (E/M) downcoding by several insurers, with providers describing inconsistent review processes, lengthy appeals, and a lack of transparency regarding payer decisions. ISC is gathering additional examples and exploring opportunities for direct engagement with affected payers.

Monitoring Emerging Coverage Concerns

ISC has also reviewed several emerging coverage issues, including denials for IV Orencia, MRI approvals for inflammatory arthritis, access to vagal nerve stimulator therapy, and drug shortages of tocilizumab biosimilars (see story below). The committee continues to monitor these issues and identify opportunities to support clinicians and patients through targeted advocacy efforts.

Looking Ahead

As payer policies continue to evolve, ISC remains committed to identifying barriers to care, reducing administrative burden, and advocating for policies that reflect evidence-based rheumatology practice. The committee appreciates the concerns and real-world examples shared by Rheum Advocates and encourages members to continue bringing forward issues they are seeing in their practices. Together, we can help ensure patients receive timely access to the care and treatments they need.

Have an issue you would like ISC to consider? We encourage practices and clinicians to share payer challenges, coverage concerns, and patient access barriers with ACR staff so they can be evaluated for future committee discussion and advocacy by writing to practice@rheumatology.org.

Tyenne (tocilizumab-aazg) Supply Shortage Member Resources

The ACR is aware of the widespread shortage of Tyenne (tociliziumab) biosimilar as of July 1, 2026 due to increased demand. The manufacturer Fresenius Kabi has reported intermittent out-of-stock periods of the drug and is unable to provide estimated restock dates. As a result, practices may need to work with payers to transition patients to an appropriate alternative treatment and submit an expedited formulary exception prior authorization letter citing the documented shortage.

To support practices during this shortage, the ACR has developed members-only resources, including the Tyenne Expedited Formulary Exception Template Letter and a Patient Fact Sheet, downloadable here. These resources are intended to assist practices with minimizing treatment disruptions and support continuity of care.

The ACR’s practice department team will continue to monitor the situation and will provide updates as new information becomes available. For questions or additional information, contact the ACR practice department at practice@rheumatology.org.

What Rheumatologists Should Know About the 2027 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) Proposed Rule

On July 14, the Centers for Medicare and Medicaid (CMS) released the 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule. While still analyzing the full impact of this proposal, the ACR will submit a detailed response to this rule during the comment period.

Key Fee Schedule Proposals for ACR-ARP Members

• The conversion factor (for payments outside alternative payment models) will decline by 1.68% to $32.84 from the current conversion factor of $33.40; this is a result of the expiration of a temporary 2.5% bump that was enacted by Congress for FY 2026.
  • For APM payments, the conversion factor will decline by 1.19% to $33.17.
• The fee schedule makes two major changes to evaluation and management (E/M) codes:
  • E/M reimbursement for multiple same-day services will be cut; if an E/M visit is furnished at the same time as a procedure or a post-operative appointment, the more expensive service will be paid at 100% and the other service will be paid at 50%.
  • The E/M visit complexity add-on will be changed from a flat add-on payment to a 16% payment based on the level of the relevant E/M code; this should result in a small pay bump for practitioners.
• The fee schedule makes some changes to calculations of practice expense methodology, including reducing reliance on AMA survey data to calculate practice expense and adding a practice expense “stabilizer” to prevent volatility.
• The fee schedule tightens use of remote monitoring codes by allowing practitioners to use them only for established patients and requiring that remote monitoring services be provided by regular staff, not contractors.

Key QPP Proposals for ACR-ARP Members

Several proposals in the 2027 MPFS Proposed Rule could affect how rheumatology practices prepare for future reporting:

• Traditional MIPS may sunset after 2028. CMS proposes phasing out traditional MIPS reporting after the 2028 performance year, with clinicians transitioning to MVPs. This makes it increasingly important that the Advancing Rheumatology Patient Care MVP includes meaningful, specialty-relevant measures.
• CMS proposes new Core Measure designations. These measures would serve as foundational quality measures intended to simplify reporting. Clinicians reporting through MIPS or MVPs would need to report at least one applicable Core Measure instead of the current Outcome or High-Priority measure requirement; small practices would be exempt.
• Promoting Interoperability requirements may change. CMS proposes removing the Security Risk Analysis measure from the PI category and updating electronic prior authorization requirements, including adding a new Electronic Prior Authorization Drugs measure.
• Digital quality reporting continues to expand. CMS is accelerating the move toward a fully digital quality reporting environment built on FHIR-based interoperability standards. Over time, RISE practices should expect quality measurement to rely more heavily on discrete EHR data fields.

MVP Considerations

The ACR supports CMS’s continued investment in MIPS Value Pathways (MVPs) and appreciates efforts to align reporting requirements more closely with clinical practice. As CMS moves toward an MVP-centered future, however, the Advancing Rheumatology Patient Care MVP must continue to evolve so it reflects the breadth and complexity of rheumatologic care.

Rheumatologists manage diverse patient populations with chronic and often lifelong conditions. A successful rheumatology MVP should support measurement of disease control, treatment safety, medication management, and patient-reported outcomes. Many of these concepts are already captured through rheumatology-specific QCDR measures available through the ACR’s RISE registry.

The ACR encourages CMS to continue working with specialty societies and clinical registries to ensure MVP measures remain clinically meaningful, actionable, and appropriately tailored to specialty practice without increasing unnecessary reporting burden.

To learn more about the 2027 QPP Proposed Rule, check out the MPFS Fact Sheet and Policy Comparison Table (PDF). Contact advocacy@rheumatology.org with questions and comments about these proposals.

FDA Issues REMS Safety Update on Jubbonti: Increased Risk of Severe Hypocalcemia in Advanced CKD

The Food and Drug Administration (FDA) has issued a required safety update to the Jubbonti Risk Evaluation and Mitigation Strategy (REMS), highlighting an increased risk of severe hypocalcemia in patients with advanced chronic kidney disease (CKD), including those who are dialysis-dependent.

Post-marketing reports have identified cases of severe hypocalcemia following Jubbonti administration, some resulting in hospitalization, life-threatening complications, and death. Patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m² are at particularly elevated risk.

For rheumatologists managing patients with comorbid osteoporosis and CKD, this update underscores the importance of careful pre-treatment evaluation and ongoing monitoring.

Key Clinical Recommendations

To reduce the risk of hypocalcemia in patients with advanced CKD, clinicians should:

• Assess for CKD-related mineral and bone disorder (CKD-MBD) prior to initiating Jubbonti, including measurement of intact parathyroid hormone (iPTH), serum calcium, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D
• Consider evaluating bone turnover status through biochemical markers or bone biopsy when clinically appropriate
• Monitor serum calcium levels weekly during the first month after administration and monthly thereafter
• Coordinate care with nephrology or other specialists experienced in CKD-MBD management

Patient Counseling and REMS Requirements

As part of the REMS program, healthcare providers are required to:

• Provide patients with the Jubbonti Patient Guide
• Review the risk of severe hypocalcemia and associated symptoms, such as muscle spasms, paresthesias, or cardiac manifestations
• Instruct patients to seek immediate medical attention if symptoms occur

Reporting and Additional Resources

Clinicians are encouraged to review complete safety details and REMS materials at www.jubbontirems.com or through their Sandoz representative.

Adverse events should be reported to Sandoz at 1-800-525-8747 or through the FDA MedWatch program.

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