Bipartisan optical lab choice, contracting reform bill gains support as Congress looks to halt vision plan abuses

The AOA’s push for federal action to rein in Vision Benefit Middlemen (VBM) reached another key milestone on Capitol Hill Sept. 15, when the U.S. House Energy and Commerce Subcommittee on Health formally considered H.R. 1521, a measure based on the optometry-related provisions of the DOC Access Act. The hearing followed an intensive stretch of AOA advocacy. Just days earlier, dozens of AOA Federal Keypersons fanned out across Washington, building on a year-long effort that has generated more than 1,000 doctor-led meetings with members of Congress as well as ongoing engagement with government investigators and enforcement agency officials. 

The congressional attention comes despite increased lobbying and public relations efforts by the VBM industry opposing AOA-backed reforms, further underscoring the importance of sustained doctor-led advocacy as Congress considers next steps on H.R. 1521. 

Optometry’s champions stand up and speak out    

H.R. 1521 co-sponsors, Reps. Buddy Carter, R-Ga., and Yvette Clarke, D-N.Y., were on hand to support the legislation. The bill mirrors the Senate's bipartisan Vision Lab Choice Act (S. 1716). The targeted reforms complement VBM laws enacted in nearly 25 states while addressing federally regulated plans that state reforms cannot reach.   

The reforms would:  

• Ensure doctor choice in labs: Prohibits insurance and VBM plans from requiring doctors or patients to exclusively use optical laboratories owned by the insurer.  
• Close loopholes claimed by abusive VBMs: While many states have enacted and are actively strengthening access laws, federally regulated plans (like ERISA) use harmful loopholes. This legislation will fully enforce lab choice at the federal level.  
• Require contracting fairness: Reforms the contracting process to ensure full flexibility and choice for patients and doctors.  

Together, the reforms would push vertically integrated VBMs to compete for business rather than rely on mandates directing patients and doctors into affiliated supply chains. 

Clarke illustrated examples of VBM consolidation and vertical integration at the expense of patient access.  

“These practices have resulted in companies having a monopoly in the vision market, so the same company that administers a patient's vision benefit can operate retail locations and be affiliated with filling prescriptions and manufacturing eyewear,” Clarke said. “It is clear patients deserve low cost, greater transparency, accountability and the freedom to choose their care.” 

Carter expressed the importance of access and highlighted the duopoly of VBMs and their impact on costs.  

“Two dominant vision benefit managers cover roughly 85% of the 220 Americans with vision benefits. Now we all know vision insurance is important,” Carter said. “When you've got this kind of concentration, it does not lead to competition, and therefore it leads to an increase in prices, a decrease in accessibility.”

Further support for H.R. 1521 

Experts from the American College of Obstetricians and Gynecologists (ACOG) and the Tennessee Pharmacists Association supported Carter’s points on consolidation with testimony. Carter also described an interaction with the Congressional Budget Office, when he asked for evidence of consolidation's benefits.  

“I asked them directly, ‘Give me one example of where consolidation in healthcare has decreased cost.’ They could not give me one example,” Carter said. “We’ve got to do something about this, particularly in vision and pharmacy management; otherwise, healthcare costs are never going to come down and accessibility will be impacted.” 

H.R. 1521 also found support from Rep. Troy Carter, D-La., who cited examples of how Louisiana unanimously passed bipartisan VBM reforms to preserve patient choice. He said more support was needed at the congressional level to end abuses for all, as many VBMs claim federal preemption to ignore state actions.  

“We do not need to continue to make healthcare more difficult for people to access, to convolute plans so they don’t understand what their coverages are, and play hide the ball for the American people,” he said.  

AOA continues to fight for H.R. 1521 

The AOA was not alone in its advocacy. Along with ACOG, representatives from the American Academy of Dermatology Association and the American College of Physicians testified in support of bills intended to break up consolidation and increase competition.  

The reforms address issues that many specialties, including pharmacy, are struggling with. Federally regulated plans like ERISA often create loopholes that allow VBMs and pharmacy benefit managers to continue predatory practices, including requiring patients to use optical labs or medical suppliers owned by the insurer.  

The AOA continues to fight not only for provider choice in labs and manufacturers, but for patient choice. The Carter-Clarke reforms offer the opportunity to reintroduce a competitive playing field, with patients and providers as the winners.

If you experience payer issues, contact stopplanabuses@aoa.org to enlist AOA support on your behalf.