American College of Rheumatology Responds to Proposed Medicare Advantage Changes for 2026
ATLANTA – The American College of Rheumatology (ACR) recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its calendar year (CY) 2026 proposed changes for Medicare Advantage Organizations (MAOs) and urged policymakers to codify measures in the Inflation Reduction Act, expand biosimilar availability in formularies, and streamline the prior authorization processes for MAOs.
In the letter, ACR encouraged CMS to implement provisions included in the Inflation Reduction Act to provide enrollees with an option to pay their out-of-pocket expenses in monthly installments. These measures would improve beneficiary access to medications, insurance coverage, and overall healthcare affordability for patients with chronic rheumatic conditions.
ACR also expressed support for a CMS proposal to review formulary and utilization management practices for Part D plans to increase access to biosimilars, noting that “biosimilars have the potential to promote a sustainable, robust market that encourages competition, cost savings, and better patient care.”
ACR also supported proposed reforms to the prior authorization process for MAOs with the caveat that efforts are made to ensure the proposals do not overburden providers or compromise care for MA beneficiaries. ACR also recommended data transparency from CMS on prior authorization outcomes to ensure both accountability and a health system that meets patient needs.
“We believe many of the provisions in the proposed rule are well in line with our advocacy efforts. However, we are concerned about the future of the Medicare Drug Price Negotiation Program, particularly due to the benefits it has had for patients’ access to rheumatologic treatments,” the letter concludes. “We urge CMS to partner with the ACR and use us as a valued resource of expertise and information for future proposed rules that impact these areas.”
Media Contact
Monica McDonald
mmcdonald@rheumatology.org
404-365-2162
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About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 10,000 physicians, health professionals, researchers and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.