ASGE physician leaders—Gary Richter, MD and Robin Mendelsohn, MD—represented gastroenterology at the AMA House of Delegates (HOD) Interim Meeting. The November meeting addressed critical issues affecting patient care and physician practice, including the use of AI by insurers to conduct prior authorizations and how physicians are paid for office-administered drugs and biologics.
The subject of considerable discussion was a report put forth by the Council on Medical Service that included recommendations to change how the average sales price (ASP) for biologics and biosimilars is calculated. The report was the outcome of a resolution led by ASGE at the June AMA HOD meeting that called on the AMA to remove manufacturer rebates from the ASP to ensure that Medicare reimbursement rates better align with practice acquisition costs. The resolution was referred for report.
Dr. Richter spoke in firm opposition to the report’s recommendations, noting the report had strayed significantly from the original resolution’s recommendation by offering an entirely new approach to calculating ASP that could also be damaging to physician practices that administer drugs in the office setting. The report offered no analysis of how the new, controversial, proposal, would impact physician practices. ASGE was joined in opposing the report’s recommendation by the American College of Rheumatology, the American Society of Clinical Oncology, American Academy of Dermatology, and others.
The final report approved by the HOD directs the AMA to support revision of ASP for biologics/biosimilars to “more accurately represent the cost of drugs for the physician practice.” The report also directs the AMA to encourage public and private payers to account for the costs of obtaining, storing, and administering drugs when setting reimbursement rates, and that the use of biosimilars should be incentivized only when “safe, clinically appropriate, and agreed upon by the patient and physician.”
Dr. Oz’s Remarks
CMS Administrator Dr. Mehmet Oz spoke to the HOD. He urged physicians to “push back” on orthodoxy and the status quo in science and suggested that physicians “don’t police each other well.” Other key themes from his remarks included:
- Addressing waste, fraud, and abuse in the health care system
- Investing in primary care
- Empowering patients through technology
- Addressing the burden of prior authorization, including through real-time approvals and provider “gold carding”
- Creating quality-driven payment systems
- Disincentivizing the acquisition of private practices, including by extending payment neutrality across sites of care
ASGE’s Voice
ASGE delegates ensure GI perspectives are heard during debate on issues before they are voted on as AMA policy. ASGE representation in the HOD also allows ASGE to bring forth policy ideas, as it did with the resolution on payment for biosimilars. Representation in the AMA House depends on the number of ASGE members that also hold AMA membership.