As the 116th Congress holds hearings on the high costs of prescription drugs and insurers continue to implement utilization management tools that delay access to treatments for patients, AGA is advocating for strong patient protections to ensure that patients have access to the most appropriate therapies as prescribed by their physician. Many insurers us step therapy, also known as “fail first” since a patient must fail two or more therapies before the insurer will cover the initial treatment prescribed by their health care provider. This practice is common among patients with inflammatory bowel disease (IBD) since the treatments are costly. AGA strongly believes that we must address the issue of the cost of these treatments but there needs to be basic patient protections for patients subject to step therapy protocols.
AGA, along with other physician organizations and patient advocacy organizations, support Restoring the Patient’s Voice Act, legislation introduced in the last Congress by Reps. Brad Wenstrup, R-OH, and Raul Ruiz, D-CA, that would provide patients and providers with an equitable and transparent appeals process when subject to step therapy protocols. The sponsors are expected to introduce the legislation again and AGA and our coalition partners continue to solicit support for the legislation especially given the 100 new members elected in November.
The bipartisan legislation would require employer sponsored health plans to do the following:
- Establish a clear and convenient process for physicians to appeal a step therapy protocol for their patient.
- Grants patients exceptions to step therapy under five critical circumstances.
- Expedites care by requiring a timely decision for appeals — three days or 72 hours or within 24 hours if life threatening.
AGA is working closely with the Crohn’s and Colitis Foundation, Arthritis Foundation, Digestive Diseases National Coalition, National Psoriasis Foundation, American Academy of Dermatology, American College of Rheumatology and other partners in generating support for Restoring Patient’s Voice Act.
AGA President David Lieberman, MD, AGAF, will be on Capitol Hill on March 11 advocating for Restoring the Patient’s Voice Act and we encourage members to ask their legislators to support this legislation.