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Congress fails to act on prior auth reform

Congress prevents a GI payment cut! Plus, telehealth and regulations to delink PBMs in the end-of-year package.
US Capitol
US Capitol

Congress passed a short-term continuing resolution (CR), which will keep the government funded until March 14, 2025.

This means the government will stay open for now – and the end-of-year package includes key provisions that affect you and your patients.

Top takeaways:

  • Two-year telehealth extension.

  • Reigning in pharmacy benefit managers by delinking PBM reimbursement in Medicare from the list price of drugs.

  • 2.5% increase to the Medicare physician fee schedule.

What does this mean?

Your engagement prevented a severe cut to GI payments. Thank you to our members for sending more than 700 letters to elected officials! It makes a difference to have GIs on the forefront fighting for patient care and reform for administrative burdens.

However, Congress did not pass prior authorization reform despite a $0 score from the Congressional Budget Office and bipartisan support.

This is a bigger problem in that is not limited to GI.

Congress’ failure to act and prevent delays across patient care underscores the need for permanent prior authorization reform.

This is our top priority to address during the new Congress in 2025.

We understand how these issues impact you and your practice and will work with you and our partners in specialty medicine to push this to the forefront of issues for Congress to address.

Be sure to read this weekend’s Washington Insider for more details.

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