GI policy priorities for 2021
AGA will continue its advocacy work in 2021 on the following issues and encourage you and your colleagues to get involved:
Administrative burden relief
Utilization management protocols, like prior authorizations and step therapy, continue to increase and force physicians and their staff to spend hours of extra work time each week to process the paperwork. Prior authorizations are especially troublesome because they have increased for upper GI procedures and other common procedures. Step therapy protocols have also increased for IBD patients on biologics or other high-cost therapies, resulting in patients not receiving effective therapies as determined by their physician in a timely manner.
Patient access and protections
Coverage
Coverage for patients includes the following two areas:
COVID-19 relief: The public health emergency has weakened the health care workforce with physician practices and researchers facing financial instability and threatened patient access to specialty care. To support the health care community and to combat the pandemic, the following is necessary: Increased access to personal protective equipment and medical supplies for testing and vaccination distribution and increased rapid tests, testing sites, and health care workers. The public health emergency response also requires a stronger emphasis on health equity given the disproportionate impact it has had on communities of color.
- Preserving Affordable Care Act patient protections: The Supreme Court will rule on the Affordable Care Act, a decision which threatens to dismantle the law, including provisions that require insurers to cover preexisting conditions and preventive services. With patients delaying screenings because of the COVID-19 pandemic and the increased incidence among minority and younger populations, it is imperative that preventative screening services – like colorectal cancer screenings – remain fully covered by payers. Moreover, because of the nature of GI diseases, patients often develop multiple conditions throughout their lifetime. The preexisting conditions protections in the ACA ensure that GI patients can gain the insurance coverage they need to obtain quality treatment.
Choice
Health plans and pharmacy benefit managers are using burdensome practices, such as step therapy, to limit patient access to drugs and biologics. These practices disrupt treatment and restrict individuals with digestive diseases from the medicines that work best for them.
Affordability
High out-of-pocket drug and biologics costs limit access to necessary therapies for people with digestive diseases, such as Crohn’s disease and ulcerative colitis. High out-of-pocket costs contribute to noncompliance, which in turn results in disease progression and complications and increases in overall health care costs.
Research funding
Sustainable long-term funding for federal research is critical to ensure the United States remains a leading contributor to innovative research breakthroughs. Under the current appropriations process in Congress, federal research funding can vary dramatically from year to year. Often enough, research funding for the next fiscal year is delayed by politics in Congress that result in continuing resolutions to fund the government and U.S. research institutions. Unstable funding causes a turbulent environment for investigators and is a deterrent for new investigators entering the field.
Member engagement
GIs need to engage in the policymaking process as there are too many threats and opportunities in today’s policy arena. The effectiveness of AGA’s advocacy work in the federal government is contingent upon members’ engagement in public policy. To increase physician advocacy and AGA member engagement, AGA offers the following avenues for members:
AGA political action committee
Political engagement is a powerful tool physician advocates can use to increase the visibility of GI on Capitol Hill. Political action committees (PACs) help provide access to lawmakers and their staff so that our advocates can educate them on the rationale for supporting our clinical and research priorities. Although PACs do not guarantee successes in Congress, it is important to note that contributions to legislators’ campaigns help them to be run more smoothly and effectively and allow the legislators to continue to serve their constituents. AGA PAC is a bipartisan political arm of AGA and is the only PAC dedicated to gastroenterology. Learn more at gastro.org/AGA-PAC.
Grassroots engagement
Build a relationship with your elected officials and their health policy staff by communicating with them often and offering to serve as a resource to the office on issues related to specialty medicine. AGA makes this easy with its online advocacy action center: gastro.quorum.us. Find out who your lawmakers are and research their background, engage them by email or Twitter on priority policy issues, and share stories with AGA staff about your interactions with congressional offices.
Congressional Advocates Program
This program creates a national grassroots network of engaged gastroenterologists interested in advocating for our profession and patients. Congressional Advocates are mentored and receive year-round advocacy training by AGA leadership and staff. Learn more at gastro.org/advocacy-and-policy/congressional-advocates-program.
