Across the healthcare landscape, increasing consolidation has led to a less competitive insurance market, which has reduced patient choice while increasing costs. Overall healthcare costs in the United States are higher than any other nation, and many patients are priced out of getting the care they need. Spending on prescription drugs has risen rapidly. Oncology care is at the very forefront of these industry shifts. Thankfully, Community Oncology Alliance (COA) and the American Medical Association (AMA) are working on behalf of patients and providers and advocating for change.
At Knowledge Forum, leaders from both organizations discussed the work they are doing to address these problems. Ted Okon, Executive Director of COA, reported that community oncology practices are more respected, have a greater voice and more leverage than ever before and COA is working tirelessly on their behalf. As pharmacy benefit managers (PBMs) work to narrow networks and control the delivery of drugs to the patient by requiring the use of a corporate or mail-order pharmacy, COA is working to increase the exposure of these tactics through media campaigns. Additionally, COA is taking legal action against PBMs and working with Congress and employers to expose PBMs and pass legislation.
Keynote speaker Barbara McAneny, MD, MACP, FASCO, Immediate Past President of AMA, outlined the steps AMA is taking to remove obstacles that interfere with patient care. AMA is working with national partners and insurance companies to “right-size” prior authorization. Working with state legislators, AMA is pursuing bills to address prior authorization and step therapy, advocating for more regulation of these programs. AMA is also seeking greater transparency in drug pricing and taking steps to increase market competition and combat anticompetitive practices. To streamline Medicare physician payment reforms, AMA is championing system changes focused on driving improvements to patient care, instead of adding administrative burden, and is also helping to streamline reporting requirements.