CHICAGO — Physicians and medical student leaders who gathered today at the annual meeting of the American Medical Association (AMA) House of Delegates adopted policies that will help patients access health care.
Expanding CHIP coverage to include over-the-counter drugs
To expand preventive treatments, the AMA will support expanding coverage so that patients enrolled in the Children’s Health Insurance Program (CHIP) have access to FDA-approved over-the-counter drugs.
CHIP covers a menu of health care services—check-ups, immunizations, inpatient and outpatient hospital care, lab services, and prescription medications. Yet, states may choose to limit coverage of over-the-counter (OTC) drugs based on specific medication categories or require physician prescription for coverage of OTC medicines.
“The availability of OTC medication to treat mild conditions creates substantial savings for the U.S. health system,” said Toluwalase Ajayi, M.D., a member of the AMA Board of Trustees “Enabling patients to access FDA-approved medications is a common-sense way of reducing physician visits.”
The AMA also will oppose copayments and any other cost-sharing requirements for OTC medications for CHIP patients. These out-of-pocket costs deter patients from accessing and adhering to treatment plans.
“CHIP has played a pivotal role in reducing the uninsured rate for children. OTC medications are another step in ensuring the program meets the needs of our patients,” Dr. Ajayi said.
Opposing managed care utilization review systems that have anticompetitive effects
The AMA will oppose utilization management systems used by insurers to limit patients’ access to necessary medical services.
The AMA has many policies opposing conduct that would allow corporations to interfere or create undue influence over the practice of medicine. With consolidation rampant, a large payer can dominate the definition of medically necessary care. That definition can then be used to deny access to care and the payment of medical services.
Utilization management systems are designed to evaluate the medical necessity, appropriateness, and efficiency of health care services. These systems play a crucial role in managing costs and ensuring quality but also can increase administrative burdens for physicians, potential delays or denials of patient care, and a reduction in clinical autonomy.
“Payers who control defining criteria of medical necessity determine payment of medical services. Recently, insurers have claimed this unchecked power because of consolidation, cutting physicians out of the process and driving up patients’ costs,” said Toluwalase Ajayi, M.D., a member of the AMA Board of Trustees.
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About the American Medical Association
The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.
