Advocacy & Policy
Biosimilar costs escalate for GI practices
AGA is committing to protecting patient access to care – including keeping infusions in physician offices.
GI practices are feeling the pinch when acquiring biosimilars.
This is thanks to insurance pharmacy benefit managers (PBMs) that exchange formulary placement for a rebate from the manufacturer. Insurers will pocket the rebate and shortchange the GI practices that acquire biosimilars for patients.
Background
- As recently recognized by the Federal Trade Commission, pharmacy benefit managers wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price. This can have dire consequences, as we are seeing in our practices.
- Thanks to advocacy by the medical community, Congress and regulators are waking up to PBMs anticompetitive practices and are interested to hear from physicians and patients about our struggles.
AGA position: insurers should not dictate how you care for your patients.
Media coverage
Dr. Maria Abreu
Dr. Deborah Dysett Desir
PBMs vs. patients: The hidden battle for affordable biosimilars — Healio Gastroenterology, Sept. 6, 2024
Dr. Erica Cohen
PBMs Are Stacking the Deck Against Patients and Independent Physician Practices — MedPage Today, Aug. 11, 2024
Join AGA to advocate for change
We are actively working to raise awareness of unjust insurer practices through media placements, legislative action, and by offering you resources, like this one. Please email us and let us know any other challenges we can help with.
