On April 16th, ACG’s Board of Governors, Early Career Leadership Program participants, and other senior ACG leaders will head to Capitol Hill for our 2026 Advocacy Day. This year, our theme is ‘Advocacy Takes Guts: Advancing Digestive Health’, and in the coming weeks, we’ll preview each item on our legislative agenda and give all ACG members the chance to get involved directly.
First up is a problem every gastroenterologist knows intimately: the stranglehold that prior authorization and step therapy requirements have on GI patient care. ACG has long maintained that when insurance companies leverage utilization management tools, they are effectively practicing medicine without a license.
The data behind this issue is sobering.
More than 70% of IBD patients face insurance barriers to accessing necessary first-line medications, and prior authorization has been directly linked to poor clinical outcomes. In ACG surveys, 97% of GI clinicians reported that prior authorization worsened patient care in some way, with 83% saying a delay directly contributed to a patient hospitalization. These consequences flow directly from allowing insurers to override clinical judgment they aren’t qualified to exercise.
Nowhere is the disconnect more glaring than in biologic prescribing. ACG’s guidelines are clear that patients with moderate-to-severe disease respond better to first-line biologic therapy than to treatment initiated after other options have failed, and yet 91% of insurers require failure of at least one conventional treatment before they’ll cover a biologic.
Meanwhile, the administrative burden of fighting these denials falls squarely on our practices: over 90% of ACG members report a high burden from prior authorization compliance, and in an average week, members complete zero peer-to-peer reviews with an actual gastroenterologist on the other side.
That’s why our Advocacy Day delegation will urge Congress to pass the Safe Step Act (H.R. 5509 / S. 2903), which would require insurers to establish a transparent exception process for step therapy protocols, with mandatory exemptions when a patient has already failed the required drug, faces serious harm from it, or is stable on a current treatment. More than 200 healthcare organizations, including ACG, have endorsed the bill, and it has broad bipartisan support in both chambers.
You don’t need to be in Washington to make your voice heard! Advocacy really does take guts — and it starts with a single phone call, so please reach out to your Representative and Senators today and urge them to co-sponsor the Safe Step Act.