Abstract
To the Editor: We thank Ruggiero et al for their interest in our article and emphasizing challenges surrounding current latent tuberculosis infection (LTBI) screening practices in patients taking biologics.1 We strongly agree with the authors that annual LTBI testing is unnecessary in all patients taking biologics and that LTBI screening guidelines need to be updated using research-driven evidence. In the United States, the important determinants that prompt physicians to automatically repeat annual LTBI screening include insurance company mandates requiring annual testing for prior authorization approval of biologic refills and incorporation of annual LTBI screening recommendations for patients on biologics into the Medicare Merit-Based Incentive Payment Systems, which impact physician reimbursement.
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