'All the advocacy firepower’ called up at AOA on Capitol Hill

Washington, D.C. — Problematic, oversized, lacking transparency and competition, while operating largely unrestricted; descriptions Congress knows all too well with pharmacy benefit managers (PBMs) on their radar. And the parallel to vision benefit managers (VBMs) is uncanny.

In a special policy briefing session, titled, “PBMs, VBMs and Growing Momentum for Reform at the State and National Levels,” over 500 of optometry’s advocates attending AOA on Capitol Hill, April 14-16, in Washington, D.C., heard panelists describe how vision plan abuses aren’t far removed from those currently engendering Congress’ rapt attention in the pharmacy space as impetus grows on the Hill to rein back oversteps into doctor-patient relationships.

While VBM abuses are just the topline of an extensive list of federal advocacy priorities during AOA on Capitol Hill, it is one that has seen significant developments in recent months, including:

• A Government Accountability Office investigation, spurred by Reps. Cathy McMorris Rodgers, R-Wash., and Brett Guthrie, R-Ky., influential lawmakers who chair a U.S. House committee and subcommittee, respectively, with direct jurisdiction over health care issues, into VBM consolidation, market concentration and the impact on patients.
  
• A request for information from the Federal Trade Commission (FTC), at the direction of U.S. House Committee on Oversight and Accountability Chair James Comer, R-Ky., on the agency’s role in preventing unfair and harmful practices in the vision marketplace.

The federal probes come as VBMs face a growing coalition of support from patient and provider advocacy groups, as well as bipartisan and bicameral support of legislation aimed at cracking down on anti-doctor, anti-patient policies in the marketplace, H.R. 1385/ S. 1424, the Dental and Optometric Care (DOC) Access Act.

⏩ Access the DOC Access Act fact sheet for more information.

"We’re hitting this with all the advocacy firepower that we have,” noted AOA President-elect Steven T. Reed, O.D., as he introduced panelists for the session, including:

• Terry Wilcox, CEO and co-founder of Patients Rising
• Jennifer Deakins, O.D., Texas Optometric Association (TOA) president
• Tommy Lucas, O.D., TOA director of advocacy
• Dan Frier, Esq., Frier Levitt law firm
• Yong Choe, YC Consulting

The latter two panelists, having prior experience in the PBM space, noted the necessity of a combined one-two punch of state and federal legislation, as well as regulation, in approaching VBMs. And leveraging the PBM awareness in Congress is critical.

“Five years ago, nobody knew what PBMs were; they want to live in the shadows because they essentially pull money out of the system,” noted Dan Frier, Esq. “We must battle them through state legislation, congressional hearings and federal legislation that promotes transparency and sheds light.

“The VBM industry is a bit different, but there are many analogies here, and many of the tools we’ve been able to utilize to protect patients and providers against PBMs can be applied here.”

Bringing VBM abuses into the light helps to illustrate the need for federal action, Frier noted, but it will also keep VBMs on their toes as “they’ll do whatever they can as long as they’re not being watched.”

⏩ Report difficulties with health or vision plans to stopplanabuses@aoa.org.

Yong Choe, a health policy expert, said over 230 members of Congress are former state legislators themselves—over half of Congress—and pointing out that 45 states already have passed laws to rein back abusive VBMs or dental benefit managers, as well as illustrating how these plans have sidestepped laws in some cases, is crucial and hard for legislators not to support at a federal level.

“Again, your organization is really approaching this the right way,” Choe told advocates. “These efforts take multiple years and Congresses, but you are moving in the right direction.”

While Texas Drs. Lucas and Deakins shared updates on the state’s landmark vision plan reform law, as well as lessons learned for statehouse advocates in their own approach to reform efforts, panelists discussed the importance of ‘localizing’ the issue with legislators.

“We have to stand for patients. We have to fight the fight and not throw our hands up, because it’s true that if we don’t stand strong things will never change,” Dr. Deakins shared.

⏩ Latest: Texas defends landmark vision plan law

To that end, Patients’ Rising CEO Terry Wilcox noted that, as in the pharmacy space, vision benefits are confusing for patients, and they don’t know how to advocate on this subject or even who to ask. However, it’s vital for patients to understand what’s happening so they can support efforts to reform the marketplace; such is the case, Patients Rising produced a helpful explainer video for how VBMs control pricing and decision-making.

“Working in the PBM space a few years ago, patient advocates didn’t really know what PBMs were, but now they hate them more than anyone,” Wilcox shared. “Patients’ don’t really know what’s happening to them, but they suspect something is up.”

Optometry’s federal priorities championed on the Hill

Beyond the VBM session, optometry’s advocates received the latest briefings on priority federal issues, including:

• Protecting veterans’ access to eye care
• Medicare payment reforms
• Ensuring a safer, simpler contact lens prescription verification system

Deanna Alexander, O.D., AOA Federal Relations Committee (FRC) chair, noted that these issues are familiar priorities for advocates; however, this year, they are at more advanced stages and may be decided soon.

“That’s why it’s so important for us to be working together to advance these issues on Capitol Hill while lawmakers are still deciding what direction to go,” Dr. Alexander told advocates prior to Hill meetings.

In over 300 meetings with members of Congress, optometry’s advocates canvassed the capital to bring these issues directly to lawmakers. The takeaways:

• Veterans’ access to eye care
  Chris Cordes, O.D., AOA FRC member: “Vision and eye health is the third-most requested service in the VA, outpaced by only primary care and mental health care. We’re in great demand. Our services are wanted and needed by people who have given a lot to this country. The VA should be able to utilize optometry to the highest level of licensure and training they have.”
  
  
• Medicare payment reform
  Tracy Sepich, O.D., AOA FRC member: “Medicare payments have fallen 26% for optometrists and other physicians since 2001 when adjusted for inflation. The failure of Medicare reimbursements to keep pace with the true cost of providing care, combined with the threat of year-over-year cuts, clearly demonstrates that the Medicare payment system is broken.”
  
  
• Closing the robocall loophole in prescription verifications
  Ralph Kohl, Health Care Alliance for Patient Safety (HCAPS) director, and David Cockrell, O.D., HCAPS chair: “When robocalls were first established only 3% of the U.S. population had smartphones, but now we’re close to 98%. The technology has advanced, and now this verification process should advance, too.” Kohl continued: “Patient safety is imperative in this subject. Company-driven substitution is leading to a non-transparent process in which the consumer is completely unaware of what’s happening, and they’re putting complex medical devices into their eyes without knowing what they’re actually putting into their eyes.”

HCAPS, through its partnership with industry supporters Johnson & Johnson, EssilorLuxottica and CooperVision, as well as the AOA, serves to advocate for patient safety and to protect the doctor-patient relationship, the essential foundation of personalized health care decision-making.

Interested in learning more about how the AOA and affiliates advocate for optometry? Check out these 15 advocacy highlights from 2023.

Noteworthy mentions

The AOA recognized several of optometry’s champions with AOA Health Care Leadership Awards, related to their determined efforts to advance eye health and vision care in the U.S., including:

• Brett Guthrie, R-Ky.
• James Comer, R-Ky.
• Cathy McMorris Rodgers, R-Wash.
• Delia Ramirez, D-Ill.

Advocates also heard from California Assemblymaker Evan Low, D-Silicon Valley, a candidate embroiled in a primary recount for California’s 16th Congressional District after Rep. Anna Eshoo announced she would not seek reelection after a three-decade tenure.

Additionally, Monday’s political luncheon featured keynote speaker and political pundit A.B. Stoddard. The writer for Bulwark and columnist for RealClearPolitics provided commentary on the current political landscape and polling data with the impending general election in November. Stoddard noted that while political discourse has been heated, it shouldn’t lead to disengagement.

“America is a miracle,” Stoddard said. “We may have our problems, but we need to treat America like that miracle and give her all we’ve got.”

Lastly, the AOA recognized the crucial support of industry supporters, including Johnson & Johnson Vision, CooperVision, HCAPS and Nidek.

Wall Street Journal cites AOA as ‘powerful’ nationwide force in health policy

Coinciding with the opening of AOA on Capitol Hill on April 14, a Wall Street Journal article made specific reference to optometry’s advocacy effectiveness. Columnist Andy Kessler, a technology policy observer and former hedge fund executive, cited the AOA’s “powerful” push for patient safety laws, as well as state and federal regulatory enforcement actions, including product recalls, targeting risky or unproven devices and services, as well as the deceptive advertising claims used by some investors to promote them.

Next steps to supporting AOA’s advocacy

Help build on the momentum created by optometry’s advocates during AOA on Capitol Hill—here’s how you can support the AOA’s federal advocacy:

• Access the AOA’s Action Center to encourage your legislators to cosponsor H.R. 1385/S. 1424, the Dental and Optometric Care Access Act.
  
• Access the AOA’s Action Center to encourage your legislators to support H.R. 2474, the Strengthening Medicare for Patients and Providers Act, and help bring stability to the Medicare payment system.
  
• Access the AOA’s Action Center to encourage your legislators to cosponsor H.R. 2748/S. 4083, the Contact Lens Prescription Verification Modernization Act.
  
• Encourage legislators’ awareness of efforts to safeguard veterans’ access to the full range of care optometrists are licensed to provide, and advance legislation to better recruit and retain VA optometrists to keep up with demand.

For more information or questions about the AOA’s advocacy into these important issues, please contact the AOA’s federal advocacy team at advocacy@aoa.org.