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Prior authorization and step therapy: My visit to Capitol Hill

Dr. Ketwaroo describes his experience on the Hill, meeting with elected officials as well as physicians, both GIs and from other specialties, to discuss the importance of making changes to current prior authorization and step therapy approaches.

By Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston, Texas 

Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston, TexasAs an early career gastroenterologist, I have become increasingly aware of the impact of advocacy in championing legislation important to our patients. Initially naive about health care advocacy, I owe much to AGA in preparing and arranging for opportunities to speak with elected officials and their staff on GI-related priorities and bills. As a member of the AGA Congressional Advocates Program, I received training and support in visiting Capitol Hill, discussing specific legislation and upcoming bills, writing op-eds, and hosting site visits.

Most recently, AGA sponsored my attendance at the Alliance of Specialty Medicine annual advocacy fly in. With colleagues from around the country  specialties ranging from ophthalmology to dermatology  we listened to invited congressmen and senators on important bills that can directly affect the care we provide to our patients. We had the opportunity to ask questions of these legislators, many of whom were fellow physicians, and gain advice on effective advocacy, as well as build camaraderie with our colleagues in other specialties who face similar issues.



With colleagues from Texas, and assisted by Kathleen Teixeira, AGA vice president, government affairs, we visited the offices of our congressmen and senators throughout the afternoon. During our meetings with congressional staff, we stressed the importance of making changes to current prior authorization and step therapy approaches to make it easier for our patients to access the right treatments as soon as possible. We also discussed the importance of supporting graduate medical education to ensure we have a future cohort of gastroenterologists and other specialists to meet the rising demands of our population. We were well received, and the briefs prepared by the alliance and AGA, as well as tips on effectively communicating our positions, made the whole process seamless. Discussing our own personal experiences and sharing patient stories, we found our meetings to be productive and insightful.


Now, I hope to host my congresswoman, Rep. Lizzie Fletcher, D-TX, for a site visit locally at Baylor, after a successful meeting with her aide on Capitol Hill.


None of this would have been possible without AGA’s support in arranging these presentations, meetings and physically supporting us throughout the process. I encourage all of you to utilize AGA in advocating for our patients. It is fun, high impact and incredibly insightful!


How to get involved in advocacy


Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as five minutes.    


    • Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their member of Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great impact on gastroenterology. AGA’s ongoing letter writing campaigns can always be found on,  but be sure to keep an eye out for advocacy emails, AGA eDigest and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.


    • Meetings with your member of Congress. In-person meetings are an excellent opportunity to share with your member of Congress, or their staff, how the issues that impact gastroenterology affect you, your patients and your practice. AGA has a plethora of resources to help you set up a meeting with your member of Congress, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, D.C., or your home state. If you are interested in arranging a meeting with your member of Congress, please contact AGA Public Policy Coordinator, Jonathan Sollish, at [email protected] or 240-482-3228.


    • AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. 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 who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections, and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager, Navneet Buttar, at [email protected] or 240-482-3221.


    • Congressional Advocates Program. This grassroots program is aimed at establishing 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.



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