Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
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- Rotonya M. Carr, MD, University of Pennsylvania Health System, Philadelphia
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- Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Maryland
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- Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston, Texas
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- Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore, Maryland
Drs. Mathews, Carr and Kaufman pictured above with Senator Bill Cassidy, R-LA (second from right).
Prior Authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care due to prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step Therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs due to devistating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
.@CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
