June 4, 2026

This issue covers federal grant policy changes, Capitol Hill advocacy, insurance coverage concerns, clinical research opportunities, and new RISE registry insights.

Federal Grant Rules Could be Changing: What Rheumatology Researchers Need to Know Now

On May 29, 2026, the White House Office of Management and Budget (OMB) published the most sweeping overhaul of federal grant regulations since 2013. For rheumatology researchers who depend on NIH and other federal funding, the window to respond is narrow. Comments are due July 13, 2026. The rules take effect October 1, 2026, with no transition period for active awards.

Four Changes That Could Affect You Directly

• Political pre-approval of every discretionary grant. Under proposed §200.205, senior political appointees must review and approve each discretionary award before it is issued. Scientific peer review scores would become advisory only. A highly scored NIH application on lupus, RA, or pediatric rheumatic disease could be declined if a political appointee determines it does not align with current administration priorities — with no scientific justification required.
• Publication costs are no longer automatically allowable. Proposed §200.461 would prohibit using grant funds for open-access fees, page charges, or color figures unless the original award document explicitly authorizes them. This directly conflicts with NIH's existing open-access mandate. Going forward, every grant budget must include publication costs as an explicit line item.
• Conference attendance requires pre-approval. Under §200.432, any conference attendance — including presenting at ACR Convergence — must be written into the original award. Researchers cannot use grant funds for meetings that arise after the award is signed without obtaining separate written authorization.
• Foreign collaborations face new hurdles. Proposed §200.220 would require political appointee sign-off for any foreign sub-award, collaborator, or visiting scientist on a federally funded project. Restrictions previously limited to NASA's China programs would expand across all federal assistance programs.

What's Not Changing

The indirect cost (F&A) rate negotiation system is not part of this proposal. OMB has explicitly stated it will not address indirect cost rates in this rulemaking.

What to Do Now

The ACR will be submitting comments on behalf of our members. Researchers can also submit their own comments by July 13. Comments work best when they are specific and quantify compliance burdens. Focus on the publication cost conflict with NIH open-access requirements, conference pre-approval restrictions, and the impact of political review on peer-reviewed science. Submit at www.regulations.gov, docket OMB-2026-0034.

• Audit active awards now. For any federally funded project extending past October 1, review budget structures to identify publication costs, conference registrations, and foreign sub-awards that may no longer be allowable by default. Negotiate explicit authorizations before the effective date rather than relying on historical practice.
• Build new budgets differently. For applications submitted now and in the coming months, treat publication costs, conference attendance, and international collaborations as items requiring explicit justification and approval — not assumptions.

In the coming weeks, the ACR will provide ways for members to reach out directly to their members of Congress to help educate them on how this new regulation could create increased burden on the research community and a potential loss of new discoveries in the future.

RheumPAC: Turning Rheumatology’s Voice into Power on Capitol Hill

RheumPAC is the ACR’s federally registered political action committee, created so rheumatology professionals can legally and collectively participate in federal election activities. It is nonpartisan and is the only PAC dedicated exclusively to advancing the interests of the rheumatology profession and the patients it serves.

How RheumPAC Advances Rheumatology

RheumPAC invests in federal candidates who have demonstrated support for rheumatology or who sit in key leadership and committee roles that shape health care policy. These contributions open doors for ACR leaders and advocates to educate members of Congress about issues like patient access to care, workforce shortages, research funding, and fair reimbursement.

Impact on Policy and Practice

Because of RheumPAC, the ACR advocacy team can build and sustain bipartisan relationships that are essential when advancing or defending legislation affecting rheumatology care. These relationships help ensure rheumatology is at the table when Congress debates policies on Medicare payment, prior authorization, step therapy, biosimilars, telehealth, and other priorities that directly affect day to day practice and patient outcomes.

How RheumPAC Decides Whom to Support

ACR and ARP advocacy staff analyze factors such as voting records, committee assignments, leadership roles, and the number of ACR members in a district before recommending candidates for RheumPAC support. The RheumPAC committee then reviews these recommendations, focusing on where contributions will best advance rheumatology’s policy goals, regardless of party affiliation.

The Role of the RheumPAC Committee

The RheumPAC committee is responsible for developing political fundraising strategy, donor engagement, and content that supports ACR advocacy priorities. Committee members help educate peers about the importance of political engagement, plan donor appreciation activities, and coordinate with ACR advocacy staff to maximize the impact of every dollar invested.

How to Get Involved

Members can learn more about RheumPAC, review giving options, and make secure contributions through the ACR’s online donation portal. Those interested in helping shape strategy or donor outreach can explore service on the RheumPAC committee or contact the ACR advocacy team for additional volunteer opportunities.

ACR Advances Advocacy Priorities at 2026 AMA House of Delegates Meeting

The ACR will send a delegation to the American Medical Association’s (AMA) Annual House of Delegates (HOD) Meeting, taking place June 5–10 in Chicago. As the AMA’s primary legislative and policymaking body, the HOD convenes national medical societies and specialty organizations along with state medical associations to debate and set policy on critical issues affecting patient care and physician practice.

This year, the ACR is actively advancing components of its advocacy agenda by sponsoring Resolution A118, “Addressing Proposals to Implement International Reference Pricing for Physician-Administered Drugs,” and co-sponsoring Resolution A115, “Patient Continuity Protections During Payer, PBM Changes,” alongside the Association for Clinical Oncology and the American Society of Hematology.

Addressing International Reference Pricing

Resolution A118 responds to growing state-level interest in international reference pricing (IRP) as a mechanism to control drug costs. IRP models tie reimbursement for physician-administered drugs to international price benchmarks; however, these models often fail to account for physicians’ actual acquisition costs.

This misalignment can place financial strain on practices and may ultimately limit patient access to in-office therapies, as practices may be unable to offer treatments that are reimbursed below cost. The ACR’s resolution calls for a more balanced approach, urging that IRP policies not rely solely on international indices and instead ensure reimbursement at or above acquisition cost while safeguarding patient access to necessary medications.

Protecting Continuity of Care

Through Resolution A115, the ACR and its partners are advocating for stronger patient protections during transitions involving insurers or pharmacy benefit managers (PBMs), such as mergers, acquisitions, or contract changes.

The resolution supports a 90-day continuity-of-care grace period during which patients can maintain their existing treatment plans without disruption. It also calls for honoring prior authorizations and formulary placements throughout this transition. These protections are critical to preventing interruptions in treatment that can lead to irreversible disease progression, particularly for patients with complex or chronic conditions.

ACR members are encouraged to weigh in on this work and suggest future ACR resolution focus by writing to advocacy@rheumatology.org. Many ACR-led policies have previously passed and shaped the direction of AMA policy and advocacy. These include H-1B visa policies impacting the rheumatology workforce, copay accumulator policies, third-party pharmacy benefit administrators, engagement with Medicare Administrative Contractors, payer financial incentives to switch treatments, selective application of prior authorization, step therapy in Medicare Advantage, biosimilar interchangeability, drug cost attribution in quality payment programs, pharmacy benefit manager (PBM) reform, opposing mandatory Part B drug payment demonstrations and many more.

The ACR asks rheumatologists to join or renew their membership in the AMA so this representation and work may continue. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is a member of both the ACR and the AMA adds to the strength of this effort.

ACR Urges BCBS Illinois to Reconsider Coverage Policy for Vagus Nerve Stimulation

The ACR’s Insurance Subcommittee has submitted a letter to Blue Cross Blue Shield of Illinois (BCBSIL) raising concerns about current coverage limitations for vagus nerve stimulation (VNS), an FDA-approved therapy for rheumatoid arthritis with inadequate response or intolerance to biologic or targeted synthetic DMARD as of July 31, 2025.

At issue is BCBSIL’s classification of CPT code 0908T under its Experimental, Investigational, and Unproven (EIU) services list, which designates the therapy as nonreimbursable and prevents case-by-case coverage consideration. The ACR notes that this policy framework effectively eliminates the opportunity for individualized clinical review, even in cases where VNS may be medically appropriate.

While VNS remains an emerging therapy, the subcommittee emphasizes its potential benefit for a subset of patients with complex, refractory inflammatory diseases who have not responded to standard treatments or are unable to tolerate long-term immunosuppression. Rheumatologists play a key role in identifying appropriate candidates and coordinating referrals for this intervention, making coverage pathways particularly relevant to patient care.

The ACR’s concern is not with the use of prior authorization, but with the current policy designation that precludes flexibility as evidence continues to evolve. In its letter, the Insurance Subcommittee seeks to engage BCBSIL in dialogue to better understand the rationale behind the existing classification, clarify evidentiary standards for reconsideration, and explore opportunities for policy updates as additional clinical data emerge.

This outreach reflects the ACR’s broader commitment to supporting patient-centered, evidence-informed care and ensuring that insurance coverage policies remain responsive to innovation in rheumatology treatment. Members can reach the Insurance Subcommittee by completing the Health Plan Complaint Form online or email your insurance concerns or questions to practice@rheumatology.org for direct support from the ACR’s practice team.

 Health Plan Complaint Form

Call for Lupus Trial Sites: Letters of Interest Due June 9

Help us advance equitable lupus research! The ACR is seeking U.S. clinical trial sites and researchers to join a project focused on increasing minority enrollment in lupus clinical trials.

The Training to Increase Minority Enrollment in Lupus Clinical Trials with CommunitY Engagement (TIMELY) initiative pairs specialized clinicians with community health workers to strengthen referral pathways and improve clinical trial literacy in underrepresented communities.

Who Should Apply:

• Sites with 2+ active lupus trials
• Hospitals, health systems, & community health centers
• Lupus researchers committed to health equity

Timeline:

• June 15: Letters of Interest are due
• June 15: Selected sites will be contacted
• Summer 2026: Federal funding application development will take place
• October 1: Anticipated project start time

Interested? Submit a Letter of Interest to Chambree Harris (charris@rheumatology.org) by June 15.

New RISE Registry Research Webinar: How Switching Anti-TNF Biologics Impacts RA Disease Activity

What happens when patients with persistent RA symptoms switch from IV infliximab to IV golimumab? Researcher John R. P. Tesser, MD, FACP, FACR, MACR, from Arizona Arthritis & Rheumatology used ACR RISE registry data that reveals significant improvements.

Join us for a free 30-minute webinar on June 10 at 3:00 PM ET to hear:

• Key findings showing mean CDAI scores improved from 21.3 to 14.1 within 6-9 months post-switch
• Real-world evidence on sustained disease control throughout 12 months
• Practical insights for managing patients who may benefit from biologic switching
• Live Q&A to address your clinical questions

This is a valuable opportunity to learn how research using RISE registry data is informing treatment decisions and improving patient outcomes in rheumatology.

Disclosures: John R. P. Tesser, MD, FACP, FACR, MACR