The FGS is committed to keeping you informed about pivotal bills affecting gastroenterology. Our regular updates ensure you're always aware of the latest legislative developments and any necessary actions.
With extensive experience in medical law, Chris Nuland, our legal counsel, brings invaluable insights. His expertise in representing medical professionals, including gastroenterologists, helps us navigate the evolving landscape of medical practice.
Representing FGS at the Digestive Disease National Coalition (DDNC) in Washington, D.C., Dr. DeGerome voices the concerns and viewpoints of gastroenterologists at a national level. For over thirty years, the DDNC has provided national leadership on behalf of patient organizations, professional societies, and industry interested in the full spectrum of digestive disorders.on key issues facing gastroenterologists in the state of Florida. They provide regular updates to enable members to stay informed and up to date on current legislation that is being discussed.
Non-Medical Switching is a policy used by insurers to limit prescription drug coverage to less expensive medications. This policy can be used to change a patient’s medication during the current contract without the need for a physician or patient consultation.
Insurers will argue that this policy is used to benefit patients by providing them with similar drugs at a reduced cost; however, this policy can be greatly damaging to the patient’s health and their wallet. Because this policy allows insurers to change a patient’s prescription at will, a patient could be taken off of an effective medication, disrupting their treatment, at any time. There are no guarantees that a similar alternative medication will produce the same desired effect, and further exposing the patient to potentially adverse health effects caused by the switch, which, in turn, could result in higher costs.
The FGS aligns itself with several other specialty societies in Florida including Rheumatology and Oncology on this issue and shares the same position, as follows:
Switching a patient’s coverage without the consultation of their physicians and the patients themselves is fundamentally irresponsible. These switches take stable patients and force them into unnecessary health risks and economic burdens. Insurers must be required to provide complete transparency regarding coverage and whether or not a patient will be required to make a switch before enrolling in their health plan. Furthermore, patients who are already receiving stable and effective treatment should never be forced to deviate to an alternative medication unless their physician deems it necessary for medical reasons.
Also known as “fail first,” step therapy is a policy implemented by health insurers that require patients to try and fail one or more formulary-covered medications before they will provide coverage for the originally prescribed non-formulary or non-preferred medication.
Step therapy can lead to potentially negative patient outcomes. In some cases, patients can be required to try up to five different medications with durations reaching 130 days per medication. This practice deeply prohibits a physician’s ability to provide individualized care, can sacrifice treatment time, and could lead to unnecessary patient suffering. Also, if not properly managed, step therapy could result in increased medical costs.
The Florida Gastroenterologic Society believes that a physician’s medical decision-making expertise should be the driving force behind patient treatment decisions. Choosing to base these decisions on cost rather than clinical consideration ignores individual patient variants in terms of safety, efficacy and tolerability in drug classes. Physicians should have the authority to override decisions based on the individual needs of their patients’ medical history and what they deem to be in the best interest of their patients.
Accumulator Adjustment Programs are tools used by insurers and Pharmacy Benefit Managers (PBMs) to exclude co-pay assistance as an out-of-pocket expense. Because of this, any co-pay assistance is excluded from being applied to patient’s deductible.
Patients dealing with complicated, chronic conditions rely heavily on co-pay assistance. Co-pay assistance provides patients with a means to offset the large costs associated with their medical therapies. However, when these assistance programs are excluded as out-of-pocket expenses, the cost of care skyrockets creating a potentially enormous financial burden on the patient. This leaves patients with two options: deal with the high medical costs or discontinue their successful treatment.
Patient health remains at the forefront of Florida Gastroenterologic Society’s priorities. We believe that co-pay assistance should count toward a patient’s deductible as it has in the past. We also want to emphasize that insurers have a responsibility to notify patients of any existing Accumulator A
