October 22, 2026

This issue highlights ACR advocacy and policy updates, including midterm voting guidance, AMA developments, PBM market concentration, and hurricane preparedness for rheumatology practices. You’ll also find the latest RheumPAC news and opportunities at ACR Convergence.

Get Ready to Vote: ACR Tips for the Midterms

Midterm elections are quickly approaching, and casting your ballot is a crucial way to influence the public policies that impact your practice, your research, and your patients. Check out a few tips from the ACR as you start thinking about heading to your polling place on November 3.

Looking for resources to share with your patients? Check out Vot-ER’s Resource Hub for ways to engage your colleagues and patients on all things civic engagement, voter registration, and voter activation!

1. Check Your Registration

If you have previously registered to vote, now is a good time to check whether your registration is still current at Vote.gov or through your State Election Board website. If you have moved, gotten married or divorced, or experienced other life events that resulted in a name or address change, it is a good idea to make sure your information is correct. This will ensure that your registration is current and that you know the correct polling location.

2. Make a Voting Plan

This might seem a bit unnecessary now, but you are a busy professional. Work gets busy, and life sometimes gets even busier. Making a voting plan now will help you determine exactly how voting will fit into your already busy schedule. Check the early voting periods offered in your area to see whether they include weekends or align with already scheduled time off, a lighter patient day at the office, or a day when you might be able to vote before or after work.

If it’s not possible to vote early, talk with your colleagues now and work together to formulate an Election Day plan that will give all of you an opportunity to go to the polls. By planning ahead, you can make sure you get to the polls in a way that works best for you and creates the least amount of stress possible.

RheumPAC Support Comes with ACR Convergence Perks!

RheumPAC is excited to provide contributors with special donor benefits at ACR Convergence in Orlando, Florida, to celebrate your commitment to rheumatology advocacy efforts!

1. A RheumPAC donation at any level gives you access to the RheumPAC Lounge in room W305AB, located on Level 3 of the West Building (West Concourse), where you can enjoy snacks and beverages, catch up on emails, and relax on a comfortable couch!

2. A Bronze Level investment ($100 for ACR members and $50 for FITs and ARP members) allows you to attend this year’s RheumPAC Donor Appreciation event on Monday, November 9, at 7:00 PM at CrushYard Orlando.

   Enjoy dinner, a full bar, and pickleball fun! We’ll have pickleball pros on hand to run games and teach you the basics. If pickleball isn’t your style, other games will be available onsite for you to enjoy. Space is limited, so please RSVP at your earliest convenience. See you there!

3. Be sure to stop by the lounge to check out our RheumPAC swag offerings. We’ll have bone badge reels by Colette Bernard, AirTag covers, and much more!

AMA Interim House of Delegates Meeting Preview

A delegation from the ACR will attend the Interim Meeting of the American Medical Association’s (AMA) House of Delegates (HOD), taking place November 6–10 in Orlando, Florida. As the AMA’s primary legislative and policymaking body, the HOD convenes national medical societies, specialty organizations, and state medical associations to debate and establish policy on critical issues affecting patient care and physician practice.

At the Interim Meeting, delegates will debate and discuss policy issues highly relevant to the rheumatology community on behalf of the broader ACR membership. Issues on the docket include prior authorization reform, maintenance of federal research funding, guardrails on AI-directed downcoding of physician services, and protections for international medical graduates and students.

The AMA’s Council on Medical Service will also discuss a resolution on international reference pricing (IRP) that the ACR sponsored at the June 2026 HOD meeting and that was referred to the Board of Trustees for further deliberation. The resolution calls for IRP models not to rely solely on international indices, as these models often fail to account for physicians’ actual drug-acquisition costs, leaving practices financially underwater.

The ACR is also working with other specialty societies, including the American Society of Clinical Oncology, to co-lead resolutions addressing Medicaid and protections for continuity of treatment, reducing nonmedical barriers to clinical trial participation, and addressing issues related to drug shortages.

ACR members are encouraged to weigh in on this work and suggest areas of focus for future ACR resolutions by writing to advocacy@rheumatology.org. Many ACR-led policies have previously passed and helped shape the direction of AMA policy and advocacy. These include policies addressing H-1B visas and the rheumatology workforce, copay accumulators, 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, opposition to mandatory Part B drug-payment demonstrations, and many other issues.

The ACR asks rheumatologists to join or renew their membership in the AMA so this representation and work can continue. Rheumatology’s representation in the House of Delegates is determined by the number of ACR members who are also AMA members, so every person who belongs to both organizations strengthens this effort.

Hurricane Isaias: What Rheumatology Practices Need to Know

On October 13, 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. declared public health emergencies for Florida and Alabama following Hurricane Isaias. The actions are retroactive to October 6 in Florida and October 7 in Alabama and allow HHS to authorize temporary waivers of certain federal requirements to help providers meet emergency health needs.

For rheumatology practices, the priority is continuity of care. Practices should identify disrupted appointments and treatments, maintain communication with patients, and coordinate with pharmacies and other facilities as needed.

The declarations do not automatically waive all requirements. Before changing billing or other procedures, practices should review Centers for Medicare & Medicaid Services (CMS) guidance and state Medicaid guidance for Alabama and Florida to confirm which flexibilities apply and whether an individual waiver request is necessary.

AMA Report Highlights Growing PBM Market Concentration

A new American Medical Association (AMA) report finds that pharmacy benefit manager (PBM) markets are becoming increasingly concentrated, raising important questions about competition, vertical integration, and patient access to prescription drugs.

Key findings include:

• Four PBMs control 75% of the national market for rebate negotiation, up from 70% in 2022.
• Approximately 94% of regional PBM markets are highly concentrated, compared with 82% in 2022.
• Approximately 69% of prescription drug plan lives are covered by insurers vertically integrated with PBMs, including 77% of Medicare Advantage prescription drug plan lives.
• The three largest PBMs—OptumRx, Express Scripts, and CVS Caremark—control roughly two-thirds of the national market and are affiliated with UnitedHealth Group, Cigna, and Aetna, respectively.
• The AMA warns that reduced competition could contribute to higher premiums, incomplete rebate pass-through, and lower pharmacy reimbursement, while vertical integration could disadvantage independent competitors.

For rheumatology, continued consolidation and vertical integration pose a particular threat to independent and private practices, which may have less leverage when dealing with increasingly powerful health care conglomerates. The ACR has a long history of advocating for meaningful PBM reform to increase transparency, promote competition, protect physician-directed treatment decisions, and preserve patient access to needed therapies.

Those efforts will continue as the ACR works with our partners to combat excessive vertical integration and ensure a competitive health care marketplace in which independent rheumatology practices can thrive.

Read the full AMA report >

RheumPAC’s Annual Matching Campaign Is Underway

Exciting news! RheumPAC has officially kicked off its annual Matching Campaign! Now through November 13, ACR volunteer leaders have pledged to match each contribution dollar for dollar. This means your contribution is instantly doubled!

There’s no better time to make an investment and support the work RheumPAC does on Capitol Hill on behalf of rheumatology clinicians, professionals, and their patients. As the only nonpartisan federal PAC dedicated exclusively to the interests of the rheumatology profession, RheumPAC uses 100% of its contributions to support and educate congressional lawmakers on policies affecting rheumatology providers and patient care.

Ongoing priorities include shaping health policies, addressing workforce shortages, and building crucial relationships with policymakers.

If you are wondering how much others tend to invest, ACR members are contributing an average of $205 this year.

Contribute to RheumPAC today >