An Update From the AOA
Consolidation in the vision insurance market rings of similar anti-competition, anti-patient alarm bells accused of pharmacy middlemen, the U.S. House’s chief investigative panel notes in launching the government’s most forceful probe yet into vision benefit managers (VBMs).
In a Nov. 18 letter to U.S. Attorney General Merrick Garland, House Committee on Oversight and Accountability Chair James Comer, R-Ky., is demanding documents from the Department of Justice (DOJ) to evaluate the patient effects of market consolidation among VBMs and their vertical integration with manufacturers and retailers. The investigative committee’s probe is its second in as many years aimed at documenting how such consolidation affects consumers’ costs and choices, and tracks with ongoing inquiries into large pharmacy benefit managers (PBMs).
“The Committee on Oversight and Accountability is continuing its oversight of the impact consolidation in vision care markets has had on consumers. Consolidation in the vision insurance market raises concerns about the potential for increased costs to patients and fewer choices,” reads Rep. Comer’s letter.
“Just like the bipartisan Dental and Optometric Care Access Act, the AOA and ADA-backed bill before the U.S. House and Senate, and optometry-led state legislation directly targeting plan abuses, the expanding Congressional and government agency investigations into VBMs are bringing important information to light,” says AOA President Steven T. Reed, O.D. “Patient choice and the doctor-patient relationship are at the foundation of advancing eye health and vision care, while VBM business tactics continue to undermine, confuse and create new barriers to the essential care that’s needed in every community we serve.”
CONTROL OF MARKET SHARE
In his letter to the Attorney General, Rep. Comer calls attention to two companies that control 85% of the market share for standalone vision insurance plans. In all but eight states, one company holds a plurality of the market, and in 28 states, one company controls more than 75% of the market.
The committee expresses concerns that VBMs have vertically integrated the supply chain for vision care, steering patients to their own stores and charging plan sponsors higher rates.
“This type of consolidation and anticompetitive practices are similar to those found by the Committee in its investigation into PBMs. The Committee identified several examples of PBMs utilizing their position as middlemen and vertical integration to steer patients to entities they own, drive competitors out of business, increase costs for patients, and utilize market opacity to prevent oversight of their actions. The Committee is concerned that these same practices are being used by VBMs to the detriment of patients,” Rep. Comer continues.
In setting a one-week deadline for information, Rep. Comer notes the “Committee on Oversight and Accountability is the principal oversight committee of the U.S. House of Representatives and has broad authority to investigate ‘any matter at any time.’”
FEDERAL INVESTIGATIONS
This latest inquiry from the House Oversight and Accountability Committee continues to heap scrutiny on VBMs and their market effects with three additional federal investigations already underway, including:
- August 2023. Rep. Comer’s initial probe pushing the Federal Trade Commission to clarify the agency’s plan for preventing unfair and harmful practices in the vision coverage marketplace.
- February 2024. Reps. Cathy McMorris Rodgers, R-Wash., and Brett Guthrie, R-Ky., influential lawmakers who chaired a top U.S. House committee and subcommittee, respectively, with direct jurisdiction over health care issues, spurred a Government Accountability Office investigation into VBM consolidation, market concentration and its impact on patients.
- June 2024. The U.S. Senate Committee on Appropriations launched a new federal probe into VBM abuses and the growing trend of VBMs and other plans sidestepping state vision plan protection laws by inappropriately claiming federal preemption from those laws. The Senate panel echoed the case that AOA and the American Dental Association (ADA) are making to the U.S. Supreme Court.
LEGISLATIVE ACTION
Beyond the congressional probes, optometry’s advocates have worked alongside the ADA and others to build support for legislation that would rein in many VBM (and dental plan) abuses, in the form of the Dental and Optometric Care (DOC) Access Act, H.R. 1385 / S. 1424. With nearly 90 bipartisan cosponsors in the House and a dozen bipartisan cosponsors in the Senate, the DOC Access Act would prohibit plans from:
- Limiting patients’ and doctors’ choice of labs.
- Price fixing for noncovered services and materials.
- Forcing never-ending contracts with doctors
Additionally, the DOC Access act enjoys the support of more than two dozen patient and consumer advocacy groups, including Patients Rising, the National Consumers League, the Hispanic Leadership Fund and the Southern Christian Leadership Conference.
Even at a state level, VBM market control is something piquing lawmakers’ concerns. In August, the AOA’s State Government Relations Center staff and volunteers painted the stark, real picture of the depths of VBM-dictated policies and how they infringe upon the doctor-patient relationship during a national forum for state legislators.
OPTOMETRY VOICES CONCERNS
Nearly 9 in 10 doctors of optometry answered that “challenges with health and vision plans” is the most pressing issue impacting optometry today when polled during the AOA’s Town Hall on Reimbursement and Coverage Fairness in October. What’s more, 98% of respondents indicated that plans create barriers to renegotiating fee schedules.
Those realities of practice are what fuel the AOA’s and affiliates’ multipronged strategy for curbing health and vision plan abuses, an effort that has driven over $2.9 million back into optometry practices nationwide, Dr. Reed announced during the AOA’s second town hall. In fact, the AOA has helped find resolution in over 200 concerns flagged by doctors in the past 14 months.
Tens of millions of Americans rely on their local doctors of optometry for their comprehensive eye health and vision care needs, and even despite historic advancements in optometry’s scope and level of care provided, plans haven’t sufficiently kept pace. In fact, compounded by increased costs and new challenges to care delivery—be it supply chain disruptions or staffing issues—plans’ stagnant pay scales and anticompetitive policies have put doctors of optometry in a difficult position.
TAKE ACTION
The AOA and affiliates understand this dynamic and are advocating for an equitable system that fairly values optometric care. Here’s how you can support these efforts:
- Use the AOA’s Action Center to write Congress about the DOC Access Act and encourage their support of this critical federal legislation.
- Access the AOA’s fact sheet for additional information on the DOC Access Act and why VBM market control is hurting patients and their doctors.
Read the WO story on AOA on Capitol Hill.
Feature photo: Marjolijn Bijlefeld
