News from the AGA

Insurance barriers should not hinder step therapy treatment for IBD


As part of Crohn’s and Colitis Awareness Week 2017 (Dec. 1-7), AGA participated in a congressional briefing sponsored by Takeda and the California Life Sciences Association highlighting advances in inflammatory bowel disease (IBD) therapies, as well as the barriers that patients face in receiving proper treatment for managing their disease.

Physician perspective

Michael Weinstein, MD, representing AGA and the Digestive Health Physicians Association, discussed how treatment options have changed considerably since he began practicing in the 1980s when the only treatment options were immunosuppressive drugs or high-dose steroids that led to dangerous side effects. He highlighted the burden that physicians face with prior authorization practices, especially step therapy in which a patient is required to fail several therapies before being granted coverage to the preferred, physician-prescribed therapy. These insurance protocols can have dire effects on patient care and can be very disruptive to patients who may be so ill that they cannot work or go to school. Dr. Weinstein stated that the burden step therapy places on his practice requires him to have a full-time employee just to navigate the various insurance policies. Many small practices do not have the resources to handle these burdens. Read more from Dr. Weinstein in his op-ed from The Hill.

Patient perspective

Members of Congress and congressional staff heard compelling testimony from Kate Detwiler, an IBD patient who spoke of her family history of IBD, her experience with the disease, and how disruptive it has been to find the best provider and treatments to manage her disease. She and Dr. Weinstein both stressed the financial burdens that the disease puts on families and how limiting it can be to patients who are starting out in their careers or school.

Legislator perspective

Rep. Brad Weinstrup, R-OH, and Rep. Raul Ruiz, D-CA, addressed the briefing as the lead sponsors of HR 2077, the Restoring Patient’s Voice Act, which would provide patients and providers with a clear, equitable, and transparent appeals process when subject to step therapy protocols. Both Rep. Wenstrup and Rep. Ruiz are physicians and have seen the real-life consequences of these policies and their impact on patient care. Both representatives stressed that this is a bipartisan, commonsense solution to ensuring that patients have access to the care that they need when they need it.

AGA continues to advocate for support and passage of HR 2077 and thanks those members who have contacted their members of Congress to request their support. If you haven’t already, please call on your legislator to support this legislation. We will continue to work to garner additional support for the bill in this Congress.

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