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Ohio Getting a Better Deal from PBMs, but Many Questions Remain

posted: October 7, 2019
More information can be found on Ohio.com. Read the Full Article

Ohio’s Pharmacy Benefit Managers back in Spotlight of Medicaid Oversight Panel

posted: September 23, 2019
Find out more on the Columbus Dispatch. Read More

OAR President Dr. Stephanie Ott Presents Advocacy Update at Annual Conference

posted: September 4, 2019
OAR members and attendees at the annual conference on August 24, 2019 who attended Dr. Ott’s Advocacy Update session heard a summary of all the activities OAR has conducted over the course of... Read More

OAR Submits Comments to the Ohio Department of Medicaid on Improving Managed Care

posted: September 4, 2019
In July, OAR summitted comments to the Ohio Department of Medicaid (ODI) in response to their request for information on how to make improvements to Ohio Managed Care Program (MCP). Comments... Read More

Pharmacy Benefit Manager (PBM) Transparency Increases in Ohio

posted: September 4, 2019
The practice of “clawbacks” and gag restrictions has been witnessed in every state and has resulted in over a dozen lawsuits across the country despite recent, enacted federal law. PBMs... Read More

International Pricing Index Model (IPI) Proposal Fails in Ohio

posted: September 4, 2019
In May, a proposal was made to the budget bill under consideration by the legislature which included an amendment to put the International Pricing Index (IPI) model in state law. OAR holds that... Read More

Empowering Patients to Advocate for Timely Prior Authorizations

posted: September 4, 2019
In June, OAR mailed out handouts to provider offices containing information on how to contact the Ohio Department of Insurance (ODI) to file complaints for prior authorization violations. The... Read More

OAR Takes Action to Support Increasing Federal Funding for Bone Density Testing

posted: September 4, 2019
OAR holds that establishing adequate federal funding for osteoporosis testing is critical in order to prevent patients from being under-diagnosed and under-treated for this debilitating and deadly... Read More

Utilization Management Protocol Reform Measures Expected this Fall

posted: September 4, 2019
Legislation to address non-medical switching practices in the state is expected to be filed this fall. The measure seeks to prohibit switches for those covered by a health benefit plan and in the... Read More

Ohio Doctors, Patients Frustrated by Policy That Requires Switching Medications: Survey Finds

posted: July 25, 2019
CLEVELAND, Ohio — Health care systems nationwide are using a policy called non-medical switching, which requires doctors to switch patients from a medication they’re using to a... Read More

DeWine’s Vetoes on Pharmacy Benefit Manager Revamp Get Mixed Reviews

posted: July 19, 2019
Many of Gov. Mike DeWine’s 25 budget vetoes had to do with sweeping reforms to the pharmacy middlemen serving the state’s Medicaid system, but the governor insisted that he remained committed to... Read More

Dispatch Analysis: State’s Attempt to Curb Drug Middlemen Mostly Futile

posted: June 23, 2019
A Dispatch analysis of prescription drug prices for the poor and disabled since the state’s latest stab at reform turns up one simple fact: No matter what laws or regulations are changed, as long... Read More

Pharmacy Benefit Manager Reform: Lessons from Ohio

posted: June 20, 2019
Addressing soaring prescription drug prices is a health care reform priority in the United States. While the pricing practices of pharmaceutical companies have been a subject of intense scrutiny... Read More

OAR Advocacy Day Highlights

posted: May 20, 2019
The OAR Joint Advocacy Day with the Arthritis Foundation was a huge success with record physician participation. There were 20 rheumatology professionals representing OAR in 22 of the 37 legislator... Read More

Strides Made Toward Increasing PBM Transparency in Ohio

posted: May 20, 2019
There are two PBM transparency bills in the legislature this year. One bill that has gained traction in the House is HB 63, The Prescription Drug Co-pay Integrity Act, sponsored by Rep. Scott Lipps... Read More

Non-Medical Switching Reform Bill Nears Introduction

posted: May 20, 2019
Legislation to reform non-medical switching practices is expected to be filed by Representative Scott Lipps (R) in the coming weeks.  The legislation seeks to prohibit switches for those... Read More

Legislation to Reform Accumulator Adjustment Programs in Sight

posted: May 20, 2019
OAR is opposed to copay accumulator programs currently being used as a new utilization management tool by health insurers. Under accumulator adjustment programs, patients must pay off the full... Read More

CareSource Formulary Change Update

posted: May 20, 2019
OAR received notice in March that changes would be made to the CareSource Formulary effective April 1, 2019 concerning the removal of Humira for RA indications from the CareSource formulary for OH... Read More

OAR Addresses Prior Authorization Complaint

posted: May 20, 2019
OAR has been working on third party prior authorization compliance issues for the past several months. In April, OAR President Dr. Stephanie Ott met with policy staff from the Ohio Department of... Read More

OAR Submits Letter to CMS

posted: May 20, 2019
In April, OAR submitted a letter to several Ohio Congressman asking them to urge the Centers for Medicare and Medicaid (CMS) to abandon the International Pricing Index Model (IPI) for Part B Drugs.... Read More

CVS Caremark Dumped by Big Medicaid Insurer

posted: April 9, 2019
The way Ohio delivers prescription drugs to Medicaid recipients underwent a major change Tuesday. CareSource, by far Ohio’s largest Medicaid managed-care provider, announced that it was... Read More

Step Therapy Legislation Passes in Ohio

posted: February 27, 2019
In a huge win for Ohio advocates, former Governor Kasich signed the step therapy bill into law on January 4, 2019. Patients will now be provided a clear process to override step therapy protocols... Read More

Ohio Non-medical Switching Legislation Update

posted: February 27, 2019
OAR President Dr. Stephanie Ott and OAR government affairs traveled to Columbus to meet with State Representative Scott Lipps to talk about Ohio non-medical switching legislation. Rep. Lipps has... Read More

ODI and Prior Authorization

posted: February 27, 2019
As a result of legislation passed in 2016 of which OAR supported, Ohio Insurance Law requires insurers and plans defined time limits on which they must respond to prior authorization requests. OAR... Read More

OAR Signs on to CMS Comments on IPI

posted: February 27, 2019
The OAR prepared a letter early this year for membership to use offering comments on the proposed International Pricing Index Model (IPI) for Part B drugs. The OAR letter urged the administration... Read More

New Legislation Addressing Accumulator Adjustment Programs on the Rise

posted: February 27, 2019
Accumulator Adjustment Programs, also known as “out-of-pocket protection” or “coupon adjustment” programs, are a new utilization management tool being used by insurers and... Read More

Step Therapy Bill Signed into Law! What Next?

posted: January 8, 2019
Ohio Governor John Kasich has signed the step therapy bill into law! Patients will now be provided a clear process to override step therapy protocols in the state of Ohio. Thank you to everyone who... Read More

CMS Releases 2019 Medicare Physician Fee Schedule Finalized Rule

posted: December 11, 2018
Included in the proposed changes were plans to collapse evaluation and management codes (E/M) levels 2-5 under a single payment rate. CMS argued a single blended payment rate would reduce... Read More

CMS Unveils IPI Demonstration Project

posted: December 11, 2018
 In a speech to the Department of Health and Human Services in late October, President Trump unveiled his administration’s new plan to reduce Medicare’s costs for prescription... Read More

Step Therapy Legislation Nears Finish Line

posted: December 11, 2018
In a huge win for Ohio advocates, two important pieces of step therapy legislation have been voted out of committee. House Bill 72 and Senate Bill 56 were introduced in February but sat in... Read More

UHC Reverses Downcoding Decision

posted: December 11, 2018
Earlier this year, UHC announced that they would no longer reimburse complex administration codes (96413 and 96415) for four biologic drugs — Actemra, Entyvio, Orencia and Simponi. They would... Read More

Ohio Election Recap

posted: December 11, 2018
The 2018 midterm elections are officially over, with only a few races still undecided. While critics continue to debate whether the 2018 midterm election results resulted in a “blue wave... Read More

OAR Presents Advocacy Update At Annual Meeting

posted: September 26, 2018
Rheumatologists from around Ohio gathered in Columbus from August 24 - 25, 2018 to attend the OAR 13th Annual Meeting. During the two day meeting, attendees were treated to a robust agenda filled... Read More

Paramount Revises Viscosupplementation Policy

posted: September 26, 2018
Paramount has made changes to their policy regarding viscosupplementation for osteoarthritis of the knee which will impact patients’ ability to access appropriate therapeutic options... Read More

Step Therapy Legislation Struggles To Move Forward

posted: September 26, 2018
Legislation aiming to better protect patients from step therapy has continued to stall in the Ohio legislature. House Bill 72 and Senate Bill 56 were introduced in February but both have yet to be... Read More

PBM Bill Continues To Make Progress In Ohio Legislature

posted: September 26, 2018
A bill seeking to reform PBM practices passed through the Ohio House earlier this summer and has been introduced in the Senate. House Bill 479 would prohibit the practice of PBMs requiring... Read More

OAR Signs on to Drug Pricing Comments

posted: September 26, 2018
The OAR signed on to the Coalition of State Rheumatology’s (CSRO) comments submitted to the Department of Health and Human Services in response to the request for information included in its... Read More

OAR Action Alert: Tell CMS to Reject E/M Payment Changes in 2019 Proposed Physician Fee Schedule

posted: August 29, 2018
As part of the 2019 Physician Fee Schedule, CMS is proposing a number of documentation and payment changes for evaluation and management (E/M) visits that if implemented, would have a major impact... Read More

Auditor Report on Ohio’s Medicaid Managed Care Pharmacy Services

posted: August 16, 2018
The Ohio Department of Medicaid (Department) requires Managed Care Plans (Plans) to offer prescription drug benefits. However, these Plans contract third party service organizations, known as... Read More

Physician and Patient Advocates Gather in Columbus for Advocacy Day

posted: May 29, 2018
Members from OAR gather for a photo before heading to legislative meetings.Members from the Ohio Association of Rheumatology (OAR) partnered with patient advocates from the Arthritis Foundation... Read More

Step Therapy Legislation Continues to Stall in Committee

posted: May 29, 2018
A bill to provide an exceptions process for patients dealing with step therapy has continued to struggle moving forward through the legislative process in the Ohio Statehouse. House Bill 72 and... Read More

Measure to Save Patients Money at the Pharmacy Builds Momentum

posted: May 29, 2018
The Ohio Association of Rheumatology (OAR) and nearly 30 other organizations have joined the Ohio Prescription Partnership coalition to push for Pharmacy Benefit Managers (PBM) reform legislation... Read More

Are You Experiencing Problems with Ohio’s Prior Authorization Law?

posted: May 29, 2018
The OAR has taken notice that some insurers in Ohio may not be abiding by the response timeline outlined in state statute. We are asking for providers to work with their office administrators who... Read More

President Talks Drug Pricing, Releases “Blueprint”

posted: May 29, 2018
Earlier this month the President held a press conference to unveil the “American Patients First” document, which will serve as a “blueprint” to lower drug prices and reduce... Read More

State Update: OAR Continues to Fight for Step Therapy Reform

posted: February 6, 2018
The number of groups advocating for step therapy reform in Ohio is growing.  Over 61 patient and provider groups have joined Ohioans for Step Therapy Reform, advocating for legislation to... Read More

State Update: PBM Legislation

posted: February 6, 2018
OAR and over 20 other organizations have joined the Ohio Pharmacist Association in applauding new legislation aiming to end a secretive practice that is causing patients to pay more than they... Read More

State Update: OAR Joins ATAP

posted: February 6, 2018
In an effort to combat increasing drug costs, OAR recently joined the Alliance for Transparent & Affordable Prescriptions (ATAP). ATAP is a coalition of patient provider groups concerned about... Read More

Federal Update: OAR Signs onto Comments to CMS

posted: February 6, 2018
OAR and a number of other state societies signed onto the Coalition of State Rheumatology Organizations comments that were submitted to CMS in response to their proposed rules for Medicare Part D... Read More

Federal Update: OAR Urges Congress to Reverse CMS Policy

posted: February 6, 2018
OAR and over 100 other groups signed onto a letter urging Congress to immediately reverse a new Centers for Medicare & Medicaid Services (CMS) policy that will create enormous financial... Read More

Federal Update: Advocates Supporting Federal Step Therapy Legislation

posted: September 22, 2017
A congressional effort to improve patients’ access to treatment is generating widespread enthusiasm in the advocacy community. Sponsored by Rep. Brad Wenstrup, DPM, (R-Ohio) and Rep. Raul... Read More

Federal Update: Anthem Threatens Hyaluronic Acid Injections Treatment Coverage for Patients

posted: September 22, 2017
Anthem has announced that, effective October 1, 2017, Hyaluronan injections to treat osteoarthritis in the knee will be revised from medically necessary to not medically necessary. Any patients... Read More

Federal Update: OAR Signs onto Letters to CMS

posted: September 22, 2017
OAR and a number of state societies signed onto the Coalition of State Rheumatology Organizations comments that were submitted to CMS in response to proposed revisions for 2018. Medicare... Read More

State Update: OAR Strongly OPPOSES Issue 2

posted: September 22, 2017
On November 7th Ohioans will face a ballot question known as Issue 2. This initiative sounds like a commonsense solution to combat high drug pricing, but when put under the microscope this issue... Read More

State Update: Step Therapy – Where We Stand

posted: September 22, 2017
Over 50 patient and provider organizations are supporting the step therapy legislation in Ohio. The Ohio Step Therapy Coalition is meeting this week in Columbus for a fall advocacy day that they... Read More

State Update: OAR Annual Meeting Highlights Advocacy

posted: September 22, 2017
The Ohio of Association of Rheumatology’s Annual meeting in Columbus kicked off their sessions with an advocacy update and discussed the importance of members getting involved in the issues... Read More

State Update: 4th Annual Arthritis Advocacy & Access Day Focuses on Step Therapy

posted: May 1, 2017
Over 30 Ohio Association of Rheumatology (OAR) and Arthritis Foundation (AF) advocates from around Ohio gathered at the Capitol in Columbus on Thursday, May 4 to educate lawmaker’s on their... Read More

State Update: Transparency in Drug Pricing: Regulating Pharmacy Benefit Managers (PBMs)

posted: May 1, 2017
One of the many legislative priorities OAR spoke about during its recent advocacy day included regulating PBMs influence over drug pricing. The recent EpiPen fiasco has lawmakers and citizens up in... Read More

Federal Update: Obamacare Repeal & Replace Bill Passes House

posted: May 1, 2017
In their second attempt this year House Republicans managed to garner enough votes to pass legislation that would replace Obamacare. The final vote narrowly passed 217-213 with 1 not voting.Repeals... Read More

Federal Update: Federal Step Therapy Bill Filed

posted: May 1, 2017
In April, Congressman Brad Wenstrup (R-OH) and Congressman Raul Ruiz (D-CA) introduced The Restoring the Patient’s Voice Act. The bill was created based off the step therapy legislation in... Read More

State Update: 2017 Legislative Issues

posted: January 1, 2017
The OAR will be riding momentum into 2017 that was generated by helping advocate biosimilar substitution and prior authorization legislation into law. While stakeholders fell short with step... Read More

State Update: Prior Authorization Law Now in Effect

posted: January 1, 2017
The Ohio State Medical Association (OSMA) has provided a guide for implementation of the new prior authorization law in Ohio. Provisions in the legislation partly take effect in 2017 with the rest... Read More

State Update: OAR Leads Downcoding Discussion with CGS

posted: January 1, 2017
CGS Administrators, the Medicare Contractor for Ohio and Kentucky, issued a report that seems to justify downcoding complex drugs to simple coding by explaining that classifying these biologics as... Read More

Federal Update: FDA Announced Final Guidance on "Nonproprietary Naming of Biological Products"

posted: January 1, 2017
The FDA announced the release of the final guidance on the “Nonproprietary Naming of Biological Products.” The agency has decided on a naming convention that supports a distinguishable... Read More

State & Federal Election Update: Trump White House

posted: November 10, 2016
What does it mean now that the businessman from New York, Donald J. Trump, will be the next President of the United States? For starters, President-Elect Trump has been a vocal advocate of... Read More

State & Federal Election Update: “Fair” Drug Pricing Ballot Initiative Fails in California, Ohio Next to Decide

posted: November 10, 2016
Ohioans may remember the Ohio Drug Price Relief Act that the Ohio Supreme Court ruled invalid due to questionable signatures gathered by the Aids Healthcare Foundation back in August. That same... Read More

State & Federal Election Update: Congressional & State Incumbents Hold Ohio

posted: November 10, 2016
The Republican majorities in the U.S. House and Senate were considered at-risk by many political analysts going into election night on Tuesday. However, not much changed throughout the United... Read More

State & Federal Election Update: Post-Election Advocacy

posted: November 10, 2016
The OAR has been preparing to engage lawmakers post-election as session in the House and Senate is scheduled to reconvene beginning next week. Step therapy and biosimilar substitution legislation... Read More

State Update: Lawmaker's Prepare for Summer Break

posted: May 1, 2016
Advocates have been scrambling to engage Ohio legislators as the General Assembly prepares to adjourn for summer break. The OAR has actively advocated in support of several key issues this session... Read More

State Update: Advocacy Tips: Preparing to Engage an Elected Official

posted: May 1, 2016
As the OAR provides opportunities for advocacy, it is important that the individual advocate prepare for future engagement with policymakers. To help, the OAR government relations team has provided... Read More

Federal Update: Part B Stakeholders Testify before Congress

posted: May 1, 2016
Coalition of State Rheumatology Organizations (CSRO) testified before the Subcommittee on Health in opposition to the recent Medicare Part B Demo proposed by CMS. The hearing, "The... Read More

2016 Arthritis Access & Advocacy Day

posted: April 21, 2016
Presented by Ohio Association of Rheumatology and Arthritis Foundation Columbus, OhioLeft: Rep. Dorothy Pelanda Right: Rep. Steve HuffmanOhio Association of Rheumatology and the Arthritis... Read More

State Update: Ohio Drug Price Relief Act (2016)

posted: April 1, 2016
The Ohio Drug Price Relief Act has been an ongoing ballot initiative started by the AIDS Healthcare Foundation, which is located in Los Angeles, California and the Ohioans for Fair Drug Prices. The... Read More

State Update: OAR's Legislative Initiatives

posted: April 1, 2016
The Ohio legislature has seen little activity for the beginning of the 2016 legislative season thus far. Moving forward, April and May could prove to be vital months for current legislation OAR has... Read More

State Update: Infusion Downcoding Concerns

posted: April 1, 2016
The OAR has been reviewing complaints from members about changes to complex chemo codes by Ohio’s MAC carrier, CGS. CGS and other MAC’s around the country have recently been... Read More

Federal Update: CMS Medicare Part B Proposal Draws Criticism

posted: April 1, 2016
More than 300 groups, including the Ohio Association of Rheumatology, are urging House and Senate leadership to press CMS to permanently withdraw the Innovation Center experiment to overhaul... Read More

Ohio’s District 46 Representative Michael Sheehy visits Arthritis Associates of Northwest Ohio in Toledo

posted: May 1, 2015
Ohio’s District 46 Representative, Michael Sheehy (center) with OAR Board Member, Dr. Edward Goldberger (left) at May 2015 in-house practice visit.In May, Ohio State Representative Michael... Read More

2015 Advocacy Day

posted: April 14, 2015
Ohio Association of Rheumatology and the Arthritis Foundation joined together for the 2nd Annual Advocacy Day on Tuesday, April 14, 2015. Advocacy Day was a great opportunity for physicians, nurses... Read More