The Rheum Advocate: March 26, 2026

A Growing Threat to Your Infusion Care Model

The buy-and-bill model is a cornerstone of rheumatology care delivery and private practice. However, it faces increasing pressure from a convergence of federal and state policy proposals, payer practices, and drug pricing reforms. These developments could significantly disrupt in-office administration of infused and injectable therapies, with implications for patient access, practice sustainability, and clinical autonomy.

International Reference Pricing

Recent legislation in Florida (HB 697) illustrates one of the most direct threats. The bill in its original form would have established an international reference pricing (IRP) framework that would have capped reimbursement for prescription drugs based on prices in other countries.

While intended to lower drug costs, IRP models raise significant concerns for rheumatology practices. Reimbursement caps tied to external benchmarks may fall below acquisition costs for biologics, making it financially unviable for physicians to purchase and administer therapies under buy-and-bill. More broadly, “most favored nation” pricing approaches risk creating drug access challenges and supply disruptions if manufacturers cannot sustain distribution at reduced prices.

Fortunately, the IRP language was removed from HB 697. Still, it is a reminder that well-intentioned reforms can have negative impacts for patients and providers. More importantly, it is a great example of why rheumatologists need to be engaged with policymakers at the state and federal level.

Patient Steering and Site-of-Care Restrictions

Another growing challenge is patient steering, often driven by vertically integrated insurers and pharmacy benefit managers (PBMs). These entities increasingly direct patients to affiliated specialty pharmacies and often require white bagging or clear bagging.

For rheumatologists, this can mean:.

• Loss of in-office drug administration revenue
• Fragmentation of care and reduced care coordination
• Increased administrative burden and prior authorization hurdles

These trends directly erode the viability of buy-and-bill and shift control of treatment decisions away from physicians. Even worse, this trend is forcing patients into drug acquisition models with well-established safety concerns. That is why the ACR has supported bills like HB 1461 in Maryland that would require fair reimbursement for in-office administered drugs.

Prescription Drug Affordability Boards (PDABs)

At the state level, Prescription Drug Affordability Boards (PDABs) represent another emerging policy risk. This year, the ACR is tracking 14 PDAB bills across 10 states. These boards are empowered in some states to set upper payment limits on high-cost drugs.

While designed to address affordability, PDAB actions may function similarly to IRP by imposing price ceilings that do not reflect provider acquisition costs or clinical complexity. For rheumatology practices, this creates uncertainty around reimbursement adequacy and may force practices to:

• Stop offering certain infused therapies
• Refer patients to external sites of care
• Absorb financial losses on essential medications

Looking Ahead

As policymakers continue to pursue drug pricing reform, it will be critical to ensure that solutions do not unintentionally undermine access to care. The ACR will continue to advocate for policies that preserve physician-administered therapies, ensure reimbursement aligns with actual acquisition and clinical costs, and protect patient choice and continuity of care. Connect on these issues with the ACR’s advocacy team at advocacy@rheumatology.org.

On-Demand RISE Webinar: See What’s New in 30 Minutes!

Missed the recent Introducing the New RISE: A Smarter Platform for Quality Improvement webinar? In under 30 minutes, the RISE team walked through how the updated platform supports rheumatology care, showcasing a redesigned dashboard, access to 26 quality measures, and practical ways to use RISE data and analytics without adding extra complexity.

A robust Q&A closed the session, with participants asking real‑world questions about reducing administrative burden and how RISE connects with Academic Medical Centers (AMCs) and other complex health systems—prompting thoughtful discussions with RISE staff.

Didn't attend live? Watch the free recording >

Pediatric Rheumatologists: Get involved in ACR Advocacy!

Writing a letter to the editor (LTE) in your local newspaper is an important tool for encouraging members of Congress to take action on the pediatric workforce shortage, pediatric vaccine policies, pediatric research, and Medicaid cuts! The ACR Government Affairs team would love to partner with you to draft and submit an LTE.

It only takes three simple steps:

1. Fill out the form at the link below with your information and tell us which topic you are passionate about.
2. Our team will write your draft letter and connect with you for feedback and edits.
3. Once approved, we will handle sharing your letter with your local paper and your lawmakers.

Learn more and sign up >

Share Your Science – ACR Call for Abstracts Starts April 14

The ACR and ARP invite researchers, clinicians, trainees, and interprofessional team members from around the world to submit abstracts for presentation at this year’s ACR Convergence, the premier meeting in rheumatology. Your work helps shape the evidence base that drives better care for people living with rheumatic and musculoskeletal diseases. The abstract submission site for ACR Convergence 2026 opens on April 14 and closes June 9, 12:00 PM ET.

Accepted abstracts are peer reviewed by experts in the field and featured in the ACR’s scientific program, providing unparalleled visibility for your research and clinical innovations.

What types of work can be submitted?

The ACR welcomes abstracts across the full spectrum of rheumatology, including:

• Basic, translational, and clinical research that advances understanding of disease mechanisms, diagnostics, and therapeutics
• Studies on treatment outcomes, comparative effectiveness, safety, and real-world evidence
• Quality improvement and care delivery innovations, including models of team-based care, telehealth, and care pathways
• Health services, population health, and health equity projects focused on access, disparities, and system-level change
• Education and training initiatives in rheumatology for physicians, advanced practice providers, nurses, pharmacists, therapists, and other team members

How to get started

To begin, visit the ACR annual meeting abstract submission page via rheumatology.org and log in with your ACR credentials. If you do not already have an account, you can create one before starting your submission. Once the submission site opens on April 14, you will be guided step by step through entering authors, selecting categories, uploading your abstract text, and confirming your submission.

Whether you are sharing early data, a practice-changing clinical trial, a creative educational innovation, or a small but meaningful quality improvement project, your contribution enriches the collective knowledge of the rheumatology community.

ACR RISE Registry Sheds Light on Outcomes and Inequities in Psoriatic Disease

Join us this April—National Minority Health Month—for a special RISE registry webinar highlighting new research on The Influence of Race, Ethnicity, and Historical Redlining on Psoriatic Disease Burden and Clinical Outcomes.

Using data from the RISE registry, researchers are uncovering how historic inequities and demographic factors intersect with rheumatologic care today.

Don’t miss this important conversation on advancing equity in rheumatology through data-driven insights.