More than 400 eye physicians and surgeons from across the United States are in Washington, DC, to urge Congress to end federal policies that delay patients’ access to quality medical and surgical eye care. As part of its annual visit to Capitol Hill, the American Academy of Ophthalmology (AAO) is speaking on behalf of millions of American patients who need timely access to treatments that protect vision.
Patients face delayed care due to abusive demands from insurers for prior authorization for treatment. There are also new requirements that force physicians to treat Medicare patients using insurance plans’ preferred drugs before gaining access to the physicians’ recommended treatment.
The AAO is ophthalmology’s leading voice in Washington, DC, engaging Congress and government agencies to improve the nation’s delivery of medical and surgical eye care. The ophthalmologists will meet with their federal representatives to discuss issues critical to approximately 50 million Americans who experience significant eye disease.
Top among them are:
- Prior authorization, a requirement by which physicians get approval from the insurers before it will cover a specific medicine. Medicare Advantage plans have engaged in abusive use of prior authorization delaying medically necessary treatments. A recent survey by the American Medical Association showed that on average, a medical practice will complete nearly 30 prior authorization requests for each physician every week, each taking about 15 hours for staff to process. In ophthalmology, prior-authorization abuse by Medicare Advantage plans delays care for patients who receive regular injections to preserve vision.
- Step therapy, also known as fail-first treatment, a health plan policy that requires the patient fail the plan’s choice of treatments before the physician can begin the treatment option the physician believes is more effective. This year, Medicare was allowed to institute step therapy for physician-administered drugs. Medicare’s hope is that the policy will help reduce health care costs. However, it can also delay access to optimal treatments and place massive administrative burdens on patients and physicians.
- Persistent nationwide drug shortages, which damage ophthalmologists’ ability to treat patients. Eye care is enduring an alarming increase in supply issues for commonly used drugs used in surgery and to treat glaucoma, such as erythromycin, prednisolone acetate, atropine and dorzolamide
- Federal vision research, which is vital to helping advance ophthalmology’s knowledge of eye disease and its treatment. The AAO continues to seek sustained federal funding for important vision research programs that benefit our fellow citizens.
“Without patients’ access to medically necessary care, ophthalmologists cannot protect sight to the full extent of our training,” said David W. Parke II, MD, CEO of the AAO. “We greatly value the opportunity to establish strong, bipartisan partnerships in Washington, DC. These can result in practical, cost-effective, innovative health care solutions to ensure that quality eye care reaches the more than 50 million Americans who experience significant eye disease.”