Dear Mr. Witty,
I am writing as a member of the colorectal cancer community to thank you for shifting your gastroenterology (GI) policy away from prior authorization for the remainder of the year. However, while the advance notification policy is certainly an improvement since it does not deny coverage or payment of services, this is only a short-term solution.
There are more than 1.5 million colorectal cancer survivors in the United States. All of the survivors, as well as patients that are at high risk for colorectal cancer, including those who previously had polyps removed, a family history, a hereditary syndrome, or those with conditions like Crohn’s and IBS all need timely access to surveillance and diagnostic colonoscopy. The new advance notification program will delay care by burdening providers with requirements to collect and submit patient data before performing a procedure.
Please reconsider your GI policy as it relates to diagnostic and surveillance procedures. The prerequisite to participate in the advance notification program in order to qualify for the Gold Card Program in 2024 will surely exclude many healthcare providers. Furthermore, since your estimate is that only 10% of practices will be eligible for the Gold Card Program, only a minority of practices will benefit from this program meant to streamline services. I urge you not to implement prior authorization for those who don’t qualify for the Gold Program so that patients who are already at high risk for colorectal cancer don’t have to face additional obstacles to receive the care that they need.
Sincerely,
