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FCSO Delays Stelara Policy Change in Response to FSR Concerns

First Coast Services Options (FCSO) recently announced that the drug Stelara® (ustekinumab) would be added to the self-administered drug (SAD) exclusion list. FSR opposed the change in coverage and sent a formal letter of opposition to FCSO earlier this month.

Florida Capitol building.

First Coast Services Options (FCSO) recently announced that the drug Stelara® (ustekinumab) would be added to the self-administered drug (SAD) exclusion list. FSR opposed the change in coverage and sent a formal letter of opposition to FCSO earlier this month. FCSO responded that they recognized the concerns outlined in the letter and have since delayed implementation until 45 days after the Public Health Emergency (PHE) ends.

The PHE is set to expire April 30th unless Department of Health and Human Services (HHS) Secretary Alex Azar extends the PHE for another 90 days. Parts of the CARES Act in relation to telehealth and other health regulations are tied to the PHE. FSR leadership is hopeful the PHE will be extended due to the connection.

FSR is working with the American College of Rheumatology (ACR) and the Coalition of State Rheumatology Organizations (CSRO) in collecting data as the process FCSO used to make the determination could have been unknowingly flawed. More information will be provided to FSR members once next steps have been taken.

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