capitol hill report: AAN CONTINUES WORK TO PROTECT E/M CHANGES

February 10, 2020

AAN Submits Comments in Coordinated Effort to Protect E/M Change

On January 28, the AAN submitted comments to the Centers for Medicare & Medicaid Services (CMS) related to finalized provisions of the 2020 Physician Fee Schedule. The comments are part of a coordinated effort with multiple specialty societies to protect positive changes made to the evaluation and management (E/M) codes and to ensure that the positive changes are implemented without modification or delay on January 1, 2021. The AAN has identified two key areas that opponents of the changes are likely to target. These are the complexity add-on code and the decision to exclude those E/M services provided during a surgical global period from the increase. The AAN’s comments include a robust defense of both provisions and the AAN is actively working to promote the benefits of both provisions, as well as the overall benefits of the finalized changes.

Additionally, the AAN is working with coalition partners to coordinate messages and to schedule a meeting with CMS to discuss the need to protect the new E/M coding structure and values. The AAN, along with several other specialty societies, is also conducting targeted outreach on the Hill to ensure that members of Congress are educated on the specific benefits of the finalized E/M changes. E/M remains a top priority for the AAN for 2020. The AAN is working diligently to protect the outcome of the AAN’s multi-year long, award-winning advocacy effort to maximize reimbursement for cognitive services.

AAN Member Testifies to Rhode Island House Commission on Step Therapy Protocols

Member Perspective by Jonathan F. Cahill, MD

In Rhode Island and around the United States, step therapy protocols are increasingly used as a way for insurance companies to contain costs. Step therapy protocols, by requiring the failure of one drug or more before allowing patients access to the initially prescribed medication, interfere with patient-centered decision making. They are meant to ensure that safe, appropriate, and affordable drugs are provided to patients, but problems arise when step therapy requirements dictate which drugs individuals may access, and when decisions made by patients with their doctors are second-guessed or overturned. One problem is that the definition of failure of one or another drug is not standard, and the person determining failure is not always clear (the prescribing physician, the patient, the insurance company). Additionally, some policies do not consider failures of drugs that occurred when the patient was covered by a prior health insurance plan. This is clearly not in the best interests of patients to require them to restart medications that previously were not effective or to which they were intolerant.

In my experience, step therapy protocols are becoming more prevalent and more restrictive over the past few years. In response, 23 states have enacted legislation to allow for individuals to easily apply for exemptions to step therapy protocols. In Rhode Island, the state legislature was unsuccessful in passing such legislation last year and instead has created a state commission to further study the issue and make recommendations to the legislature. I was fortunate to have the opportunity to testify before the House Committee on Health, Education and Welfare in support of last year’s bill, and I look forward to testifying again before the commission later this month. My testimony includes specific examples of patients whose medications have been denied as part of a step therapy protocol.

Most of my patients live with multiple sclerosis (MS). Since the first drug proven to alter the course of MS was approved by the US Food and Drug Administration (FDA) in 1993, there have been many advances in drug therapy to treat the disease. There are now seventeen FDA-approved disease-modifying therapies, and they are giving people with MS more control over the disease and leading to less disability over time. The decision about which medication is right for a specific patient is complicated, and influenced by the individual’s symptoms and disease course, the available testing, patient preferences, other medical issues, potential risk for side effects, and planned duration of treatment. It is essential that Rhode Island and other states, as well as the federal government, protect patient-centered medical decision making by enacting policies to make it easier for patients to seek step therapy protocol exemptions.

Note: The AAN is piloting a state advocacy strategy in 2020 to focus on step therapy, electronic prior authorization, and scope of practice threats in a select group of states. In addition to Dr. Cahill’s testimony, the AAN also submitted a letter to the state commission in support of step therapy reform.

If you are currently engaged in your state on any of these issues, please email advocacy@aan.com.