On September 9, the American Optometric Association (AOA) contributed to a robust discussion at a special panel for U.S. Senators and House members to further investigate the underlying causes behind growing abuses of vision benefit managers (VBM) and the increasingly harmful impact they are having on patients and their doctors.
VBM abuses are increasingly under fire on Capitol Hill as Congress ramps up bipartisan and bicameral probes into costly, controlling and care-limiting practices. At the request of a key U.S. House committee, members of Congress and staffers heard firsthand accounts of VBMs’ anticompetitive, costly and controlling policies from patient and consumer advocates alike as the AOA and anti-abuses lawmakers urge greater federal action.
SHARING DOCTOR-PATIENT RELATIONSHIP STORIES
In addition to representatives from the National Consumers League (NCL) and Patients Rising advocacy groups, Texas Optometric Association Advocacy Director Tommy Lucas, OD, and his patient, Monique Flores, shared their personal story of struggle and frustration owing to outsized VBM control of the doctor-patient relationship.
Since the age of 2, Flores has dealt with an astigmatism that led to severe discomfort in sunlight, requiring a lifelong need for thick, heavy lenses and an accompanying high prescription.
“My prescription is not ordinary. I can’t go to a dollar store or a pharmacy clinic or whatever and pick up something off the shelf. My eyes don’t allow me to do that,” said Flores during her panel presentation.
Working through the obstacles thrown at her by VBMs has been an uphill battle. She said getting a new pair of glasses is an insurmountable task and that “in something as simple as breaking my glasses, losing them, scratching them, whatever, I am at a complete standstill because I can’t go to Dr. Lucas and say, ‘can I get these replaced?’”
Even though Dr. Lucas can help her, she has been told repeatedly by VBMs that her insurance will only cover the replacement if he sends them to a specific manufacturer and “that specific manufacturer happens to be them.”
Later in the panel discussion, Flores was asked about her thoughts on what she wishes other patients should know about working with VBMs, saying “I think the biggest thing is understanding that it’s not what it appears to be. It’s very misleading, and I think that the biggest takeaway for me personally as a business owner and as a patient is it is not the only choice that’s out there. There are other options and better options, and we don’t have to feed this monster.”
GROWING AWARENESS AND DRIVE FOR CHANGE
The Sept. 9 Hill briefing continues to build upon the growing awareness of the fight for fair treatment of doctors and patients, as well as ensuring full accountability of anti-patient, anti-doctor VBM abuses.
Through a growing partnership of AOA, consumer and patient advocacy groups, as well as members of Congress, federal pressure is mounting on VBMs over these harmful policies. In some cases, these policies are dictating doctor-patient decisions, a troubling situation that NCL Executive Director Sally Greenberg reinforced at the briefing.
“It’s very concerning when patients can’t get the care that they need to get by just walking in the door,” Greenberg said. “…instead, there’s the lack of transparency, then steering them to their own manufacturers, their glasses makers and then charging them these outrageous prices for what should be a very standard level of care.”
Greenberg continued: “We want patients and doctors to have the freedoms to use the labs that they want to use. All that closed circle, that concentration, the lack of transparency, is having a terrible impact on consumers. And that’s where we come in and that’s where we can speak out.”
During a Q&A session at the briefing, Dr. Lucas responded to a question related to the future of eye care and the eye care market if VBMs continue to amass strength, stating that “we’re going to see less access to care, higher prices and less transparency as these closed systems continue to amass power. At this point, the VBMs pretty much exist to serve themselves, to serve their own profit-making initiatives versus the patients or the doctors’ offices that are providing the actual care.”
Terry Wilcox, founder and chief mission officer at Patients Rising, also added a poignant statement while sharing some personal anecdotes about working with both pharmacy benefit managers (PBMs) and VBMs, stating: “… anything that we can do to put more control back in the hands of patients and their doctors to be able to manage care appropriately is always going to be something that Patients Rising is fighting for.”
ONGOING INVESTIGATIONS
Congressional support remains strong, specifically surrounding the Dental and Optometric Care Access (DOC Access) Act (H.R. 1385 / S. 1424), with nearly 90 bipartisan co-sponsors and a dozen bipartisan co-sponsors in the Senate. This bill was introduced by Reps. Buddy Carter, R-Ga., Yvette Clarke, D-N.Y., Sens. Joe Manchin, D-W. Va., and Kevin Cramer, R-N.D., in 2023.
The briefing is yet another step forward in communicating and combating VBM abuses, with developments from other active investigations including:
- A Government Accountability Office investigation, spurred by Reps. Cathy McMorris Rodgers, R-Wash., and Brett Guthrie, R-Ky., influential lawmakers who chair a U.S. House committee and subcommittee, respectively, with direct jurisdiction over health care issues, into VBM consolidation, market concentration and the impact on patients.
- A request for information from the FTC, at the direction of U.S. House Committee on Oversight and Accountability Chair James Comer, R-Ky., on the agency’s role in preventing unfair and harmful practices in the vision marketplace.
- Appropriations language from the U.S. Senate Committee on Appropriations calling for a new federal probe into VBM abuses and the growing trend of VBMs and other 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 are making to the U.S. Supreme Court.
- Growing coalition support from patient and provider advocacy groups, as well as bipartisan and bicameral support of legislation that would curb anti-doctor, anti-patient VBM policies at a federal level.
And just last month, there was a presentation at the 2024 American Legislative Exchange Council (ALEC) Meeting, a national forum for state legislators, where the AOA’s State Government Relations Center (SGRC) staff and volunteers painted a stark and very real picture of the depths of VBM-dictated policies and how they infringe upon the doctor-patient relationship, harming both consumers and optometry practices.
AOA HEALTH AND VISION PLAN ADVOCACY
Doctors of optometry having issues with a VBM policy can report difficulties or challenges with health or vision plans to stopplanabuses@aoa.org. Visit the AOA’s Health and Vision Plan Advocacy page for more information about AOA’s and affiliates’ efforts or text DOC (D – O – C) to 855.465.5124 for more, including how to join in the fight to put a stop to VBM abuses.
To learn more about how the AOA is advocating on behalf of the profession, click here.
