2017-10-04 18:44:55 UTC

GIs Should be Able to Prescribe the Most Beneficial Treatments

Oct. 4, 2017

AGA supports Restoring the Patient’s Voice Act — new legislation that facilitates treatment appeals to insurance companies.

Appealing step therapy protocols can be time consuming and burdensome for physicians and patients, and can takes months to resolve. The Restoring the Patient’s Voice Act (HR 2077), introduced by physicians Reps. Brad Wenstrup, R-OH, and Raul Ruiz, D-CA, would provide a clear and timely appeals process when a patient has been subjected to step therapy by their insurance provider.  
AGA endorsed this legislation to provide patients with a clear, equitable and fair appeals process when subjected to step therapy protocols. Step therapy, also known as “fail first,” requires patients to try and fail medications by insurers before being covered by the initial therapy prescribed by their health care provider. This practice jeopardizes the physician-patient relationship, since it bypasses what the physician believes is the best treatment for their patient. Although step therapy is used by insurers as a cost-containment mechanism, it has been shown to not save money in the long run due to complications that patients suffer, which can require additional physician visits, emergency department visits or even costly hospitalizations. With the increase of biologics to treat diseases like inflammatory bowel disease (IBD), more and more patients with digestive diseases are subject to this policy.
HR 2077 would require employer-sponsored health plans to:
  • Establish a clear and convenient process for physicians to appeal a step therapy protocol for their patient.
  • Grant patients exceptions to step therapy under five critical circumstances.
  • Expedite care by requiring a timely decision for appeals — three days or 72 hours, or within 24 hours, if life threatening.
AGA is working with patient advocacy groups, like the Crohn’s and Colitis Foundation, provider and professional societies to educate members of Congress on this issue and the implications it has for patients being able to access the right treatment at the right time. We will continue to work with other stakeholders in garnering support for this critical legislation that will restore the physician-patient relationship.  

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