HONOLULU – The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Interim Meeting to shape guiding policies on emerging health care topics.
The AMA’s House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, residents, and medical students representing every state and medical specialty. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.
The policies adopted by the House of Delegates include:
Calling for federally maintained physician directory for Medicare Advantage
The American Medical Association (AMA) will urge the federal government to create and maintain a public database of physicians participating in Medicare Advantage and accepting new patients, according to new policy adopted today by the nation’s physicians and medical students. The policy addresses the expectation that Medicare Advantage plans present an accurate list of in-network physicians to help patients make informed choices and find suitable medical care.
“Patients rely on directories of in-network physicians to make informed comparisons of Medicare plans or choose a physician,” said AMA Board Member Scott Ferguson, M.D. “But patients face a false appearance of choice when Medicare Advantage plans create networks that are too thin and directories that are too flawed. A comprehensive and authoritative source of accurate information is needed from federal authorities to support patients in Medicare Advantage.”
In addition, the new policy instructs the AMA to advocate for better enforcement of Medicare Advantage regulations and work for greater accountability from the Centers for Medicare & Medicaid Services to ensure patients have transparent information access to understand which medical services are covered or uncovered by their Medicare Advantage plans.
Requiring TPAs to be included in oversight of drug middlemen
To encourage greater transparency in pharmaceutical drug coverage and pricing, the American Medical Association recommends that third-party administrators (TPA) of specialty pharmacy benefits be included in state and federal oversight efforts of prescription drug middlemen.
Regulation of pharmacy benefit managers (PBM) is on the rise in response to concerns that services these drug middlemen provide can have a detrimental impact on patients’ ability to access affordable prescription drugs. For specialty pharmacy benefits, TPAs provide many of the same services as PBMs, including developing and maintaining formularies, processing claims, and negotiating discounts and rebates between payers and manufacturers.
“Given that TPA services can have a negative impact on access and affordability for specialty drugs, the AMA will remind state and federal regulators not to ignore TPAs in their oversight of drug middlemen,” said AMA Board Member Marilyn Heine, M.D. “Specialty drugs are often a critical part of a patient’s care for cancer, certain forms of arthritis, and other medical conditions. As such, the AMA believes TPAs should be subject to the same licensing, registration, and transparency reporting requirements that regulators mandate for PBMs.”
The Interim Meeting of the AMA House of Delegates continues deliberations on policy proposals as is expected to vote and adopt additional policies before the end of the day. Please check the AMA website for updates.
Robert J. Mills
ph: (312) 464-5970
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.