Vision Benefit Middlemen (VBM) Reform

AOA Federal Priority: Restoring Choice, Lowering Costs and Protecting the Doctor-Patient Relationship 

The vision care market is currently dominated by massive conglomerates known as Vision Benefit Middlemen (VBMs), providing 200 million Americans with coverage for annual eye exams and vision correction. Today, just two dominant VBMs control roughly 85% of those with vision coverage, creating a vertically integrated system that prioritizes profits over patient care. 

These middlemen leverage their market dominance to push lopsided contracts onto optometry practices that effectively: 

• Set prices, even on products and services the plan does not cover 
• Require sales quotas of eyeglass frames and lenses that are VBM owned 
• Force use of optical laboratories that are VBM owned or aligned  
• Force use and payment for EHR systems that are VBM owned, including practice management and claims processing software 

The AOA is fighting back. Alongside patient and consumer advocacy groups, the AOA is calling on Congress and federal regulators to put an end to VBM tactics leading to higher costs, affecting the doctor-patient relationship, and diminishing access to care in communities that need it most. 

ISSUE BRIEF    ACTION CENTER

The Case for Reform: Why It Matters 

• Highly concentrated markets: In 28 states, one VBM controls more than 75% of the market. In 42 states, a single VBM holds at least a plurality. This leaves patients and doctors virtually no alternatives.  
• Vertical integration: VBMs often own their own optical labs, frame manufacturers, EHR systems and even retail outlets, ensuring they alone benefit from their market dominance.
  
• Limiting patient choice: Forced used of VBM-owned optical laboratories means longer wait times for patients’ eyeglasses and lenses.
  
• Threatening independent practice: VBMs keep reimbursement artificially low while acquiring hundreds of independent practices, systematically eroding the availability of local, community-based care. 

WATCH: The Issue in 5—The Dental and Optometric Care Access Act

Legislative Action: What AOA is Doing 

The AOA urges the U.S. House of Representatives and U.S. Senate to pass key legislation designed to restore fairness to the vision care market: 

• The Dental and Optometric Care Access Act prevents VBMs from setting prices on items/services not covered by plans and ends “never-ending” lopsided contracts.
  
• The Vision Lab Choice Act prevents VBMs from forcing patients and doctors to use optical laboratories owned by these middlemen.  

Questions? Please direct questions regarding the AOA’s federal priorities to our Federal Advocacy Team. 

VBM Reform Resources