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January 24, 2019

AGA members discuss step therapy, closing colonoscopy “loophole” with Sen. Cornyn staff

As part of AGA's Congressional Advocates Program, Baylor College of Medicine faculty met with Jay Guerrero, regional director for Southeast Texas for Sen. John Cornyn (R-TX). 

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On Jan. 11, 2019, Avi Ketwaroo, MD, Yamini Natarajan, MD, Richard Robbins, MD, and Richa Shukla, MD, along with Section Administrator Ramanveer Virk, MBA, met with Mr. Guerrero at the McNair Campus of Baylor College of Medicine to discuss AGA’s legislative priorities such as NIH Funding, the Restoring the Patient’s Voice Act (H.R. 2077) and the Removing Barriers to Colorectal Cancer Screening Act of 2017 [(H.R. 1017)/(S. 479)].


Mr. Guerrero was very interested in hearing about step therapy and the barriers this policy creates for physicians who are unable to prescribe appropriate regimens for patients with chronic GI conditions such as inflammatory bowel disease (IBD). He understood that physicians make treatment decisions based on patient specific factors and insurance mandated rules regarding medications, and that prior authorizations can pose significant delays in achieving remission — in some cases even contributing to repeated hospitalizations while patients remain symptomatic.


Our group also discussed the colonoscopy “loophole”; specifically, we noted that many other screening tests do not have the ability to perform therapeutic interventions. However, colonoscopy is unique in that one procedure can serve both screening and therapeutic purposes. The colonoscopy “loophole” prevents gastroenterologists from fulfilling their duty and performing intervention on polyps at the time of detection. Furthermore, requiring patients to return for a polyp removal adds risks including procedural and anesthesia related risks. Mr. Guerrero was very attentive to these concerns and shared his intent to discuss this information with Cornyn.


Site visits such as these promote a healthy and productive dialogue between health care providers and legislators. AGA offers several resources  to help gastroenterologists engage with legislators:


Congressional Advocates Program


This is a grassroots program aimed to establish a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community and recognition on AGA’s website. Applications for the next cycle will be released in 2019.




The AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA and is the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates that support our policy priorities such as fair reimbursement, cutting regulatory red tape, supporting patient protections and access to specialty care, and support for federal funding of digestive disease research. If you are interested in learning more, contact AGA’s Government and Political Affairs Manager, Navneet Buttar, at or 240-482-3221.




AGA’s online advocacy platform allows members to contact their member of Congress with just a few clicks. AGA develops messages on key pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great impact on gastroenterology. The platform also allows AGA to track legislation, key votes, a legislator’s priority issues and other key legislative activity. AGA can also track member activity with a legislator and their staff, a key component in building and maintaining relationships with key legislators.


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