AGA is committing to protecting patient access to care – including keeping infusions in physician offices. AGA is deeply concerned that independent practices are struggling to offer infliximab biosimilar infusions due to the high acquisition costs far exceeding reimbursement.
We have developed a templated letter that your practice can use to reach out to insurers to request a blanket exception to any infliximab fail-first mandates.
Steps to use AGA's letter
Deeper info about the runaround
- The infliximab infusion runaround is part of the concerning power of pharmacy benefit managers (PBMs).
- 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.
- Congress and regulators are waking up to PBMs anticompetitive practices and are interested to hear from physicians and patients about our struggles.
- It is primetime to get involved!
We're taking this fight to the media:
PBMs and insurers are making it harder for patients to receive timely access to biosimilars due to high administrative burdens and costs, Dr. Erica Cohen writes in MedPage Today. Give power to make treatment decisions back to doctors.
AGA president Dr. Maria Abreu in STAT
In a letter to the editor, Dr. Abreu outlines what comprehensive PBM reform looks like, including regulating white bagging mandates, delinking list price of a biosimilar drug from PBMs’ compensation and more.
