Patient Support & Advocacy

Work to close insurance coverage gaps for preventive care

Andis Robeznieks , Senior News Writer

Across the U.S. population, gaps in health insurance coverage result in people missing opportunities to achieve optimal health status.

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The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront today’s greatest health crises.

The AMA House of Delegates took steps to address three such gaps at the 2022 AMA Interim Meeting being held this week in Honolulu.

Medicare coverage rules vary across vaccines as well as Parts B and D, and these differences can act as significant barriers to vaccination. Also, administrative barriers exist as it can be difficult for physician practices to contract with multiple individual Medicare Part D plans, according to a resolution introduced at the meeting by the AMA Senior Physicians Section.

To ensure that Medicare beneficiaries get all the vaccines they need, delegates directed the AMA to advocate “that Medicare cover the full cost of all vaccinations administered to Medicare patients that are recommended by the Advisory Committee on Immunization Practices (ACIP) at the point of care and outside of budget-neutrality requirements.”

Visit AMA Advocacy in Action to learn about what’s at stake in covering the uninsured and other advocacy priorities the AMA is actively working on.

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Pre-exposure prophylaxis (PrEP) for HIV is critical to ending the HIV epidemic in the U.S., but only 25% of the approximately 1 million Americans most at risk for infection use it. Use is further hindered by a recent federal court ruling that Affordable Care Act (ACA) coverage for PrEP cannot be mandated because it runs afoul of the Religious Freedom Restoration Act, according to a resolution introduced by the AMA Integrated Physician Practice Section.

To help ensure access to HIV prevention, the House of Delegates directed the AMA to:

  • Support the continued inclusion of PrEP for HIV as a preventive essential health benefit under the ACA.
  • Support and join legal efforts to overturn the judgment rendered in Braidwood v. Becerra in the U.S. District Court for the Northern District of Texas.

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Several anti-obesity medications have now been approved by the Food and Drug Administration for use among children, substantially expanding the options for safe and effective pharmacological options for pediatric obesity treatment.

But many health insurance plans—public and private—do not adequately cover lifestyle therapy, anti-obesity medications, and metabolic and bariatric surgery, resulting in progressive weight gain and weight-related comorbidities, according to a resolution introduced by the American Academy of Pediatrics and the Obesity Medicine Association.

To address the issue, delegates modified existing policy, specifying that the AMA “work with interested national medical specialty societies and state medical associations to increase public insurance coverage of and payment for the full spectrum of evidence-based adult and pediatric obesity treatment.”

Read about the other highlights from the 2022 AMA Interim Meeting.