ACG Policy Advocates Busy Again: At Federal and State Level
From ACG Legislative and Public Policy Council Chair, James C. Hobley, MD, MSc, FACG
The ACG Legislative and Public Policy Council and the ACG Board of Governors continue to advocate on behalf of clinical gastroenterology, both at the federal and state level. This week, ACG joined a coalition of like-minded organizations urging Congress to delay a 2% Medicare reimbursement cut looming April 2021. This cut was temporarily delayed before 116th Congress adjourned in December 2020.
ACG continues to educate Congress on the importance of telehealth services, especially in rural areas and among Medicare beneficiaries. Telehealth continues to play an integral role in treating patients during the COVID-19 pandemic. Rep. Mike Thompson (D-CA) has reintroduced the Protecting Access to Post-COVID-19 Telehealth Act (H.R. 366), a bill that eliminates most geographic and originating site restrictions and requires CMS to continue coverage flexibilities beyond the end of the public health emergency.
From ACG Illinois Governor Russell. D. Cohen, MD, FACG
ACG is also active at the state and local level. The Illinois state legislature recently passed a bill that would require hospitals and health care providers to pay prejudgment interest in civil cases. ACG is working with the Illinois Medical Society in urging members to take action. If signed into law by the Governor, H.B. 3360 would require prejudgment payment of interest (at a rate of 9% a year) on claims being sought in civil cases, including medical malpractice cases. The pre-judgment interest would begin to accrue from the date the defendant has notice of an alleged injury until the time of judgment. According to the Illinois Medical Society, this bill would undermine the health care delivery system by driving up health care costs, and it could compel physicians to potentially leave the state — exacerbating Illinois' health workforce shortages.
The bill is currently sitting on Governor Pritzker's desk. ACG Illinois members: we need your advocacy voice today!. Tell the Governor to veto H.B. 3360.
ACG will continue to be a vigilant advocate for clinical GI. We are educating policymakers in D.C., as well as state legislatures and Governors across the country, urging these necessary policy changes for our patients and practices.
Register Today: COVID-19 GI Consults, Therapeutics, and Vaccine Myth-Busters
What are the top GI consults for a COVID-19 patient? Are patients, friends, or family members asking you about the latest developments in COVID-19 therapeutics and vaccinations? What are some myths and myth-busters on vaccinations?
You can learn all of this on Tuesday, February 9th! Register today for the “COVID-19 Management: Pearls for the Gastroenterologist” webinar.
Important FDA Safety Alert: Increased Risk of Heart Problems and Cancer Associated with Xeljanz
From FDA Related Matters Committee Chair Eric D. Shah, MD, MBA
On Thursday, the U.S. Food and Drug Administration (FDA) announced that preliminary results from a safety clinical trial show an increased risk of serious heart-related problems and cancer with the arthritis and ulcerative colitis medicine Xeljanz, Xeljanz XR (tofacitinib) compared to tumor necrosis factor (TNF) inhibitors. The FDA required this safety trial, which also investigated other potential risks including blood clots in the lungs and death. The final results are not yet available. The FDA recommends that health care providers should consider the benefits and risks of Xelijanz when deciding whether to prescribe or continue patients on the medicine.
Click here to read these recommendations.
GI Societies Update: United Healthcare's Remicade Coverage Changes
Effective February 1, 2021, United enacted a policy to remove Remicade as a preferred product as announced in its Medical benefit specialty drug update bulletin. However, United has made clear that patients will not be required to switch until the date of their prior authorization renewal. As per its policy, “UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Providers don’t need to submit a new notification/prior authorization request for members who already have an authorization…”
After conversations with our societies’ physician experts, United agreed to modify its coverage policy to allow pediatric patients 16 years of age and younger and currently on Remicade to remain on Remicade if that is the recommendation of the treating physician. Adult patients meeting the following conditions may be allowed to remain on Remicade, but will require the prescribing provider to request a review and a determination will be made on a case-by-case basis:
- Adult patients currently on induction of Remicade for less than 18 months will not be required to switch.
- Adult patients who are having a flare of active disease, and hence are not stable, will not be required to switch.
United is educating its medical directors as quickly as possible about these changes and will develop new member education to communicate this new policy more clearly to patients, many of whom were confused by wording of the original notice. Please contact your specialty society staff if you are encountering problems with the prior authorization process, your patient was switched without your consent or your request to keep your patient who meets the above criteria on Remicade has been denied. United has asked us to report any problems so it can continue to refine its communications and efforts as needed.
Remember to contact your ACG Governor on important state and local issues impacting you and your practice.
The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.
