Protecting Patient Access to Care

We advocate for payer, federal and state policies that improve patient results through evidence-based care, access to treatments and medications, effective community support of public health goals, and individual involvement in care for patients, families and communities. Here is what we are doing to make a difference. 

• Competition in Healthcare
Vertical integration in the healthcare system promotes conflicts of interest and reduces competition, driving up prices. The Break Up Big Medicine Act (S.3822) would limit common ownership of insurers, PBMs and healthcare providers, reducing vertical integration. We expressed support for the bill, which has been referred to the Senate Judiciary Committee. July 2026

• Push for an End to PBM Kickbacks
Pharmacy Benefit Managers (PBMs) provide incentives to brokers, consultants, advisors and  other intermediaries in exchange for steering employer-sponsored health plans or for an insurer’s business. These conflicts of interest risk compromising the care of patients across the country. We joined other community stakeholders in supporting the PBM Kickback Prohibition Act (H.R.7895), which would eliminate inappropriate kickbacks that impact decision-making. April 2026

• Transparency on Medical Bills 
The No Surprises Act Enforcement Act (H.R.4710/S.2420) would protect patients from surprise medical debts and protect health care providers from delayed reimbursement for services. Since the No Surprises Act was passed, physicians across the country continue to experience delays on reimbursement, and in some cases, they are not being reimbursed at all. We, along with other community stakeholders, wrote to Congress in support of penalizing parties who do not adhere to regulatory guidelines. May 2026

• Penicillin Allergy Delabeling Improves Preventive Care and Health Technology Infrastructure
We continue to urge CMS to incorporate penicillin allergy verification and evaluation into the Medicare Annual Wellness Visit. Recently we suggested that ongoing efforts to improve healthcare records include structured, interoperable, and clinically actionable documentation of allergy histories and outcomes, and that testing results reflect allergy criticality across care settings. June 2026

• AAAAI, Step Therapy Coalition ask CMS for Step Therapy Protections
Step therapy, or “fail first,” is a prior authorization protocol that requires patients to try a Pharmacy Benefit Manager (PBM) or insurer-preferred treatment to prove that it has failed before providing access to physician-prescribed treatment. We and members of the Safe Step Coalition urged Congress to protect patient access to care by requiring plans to implement an exceptions process, to recognize prior determinations, to standardize exceptions across payers, and to leverage technology to streamline exceptions. June 2026

• On June 4 and 5, 2026, the AAAAI Board of Directors met with more than 20 members of Congress and legislative staff to discuss key issues impacting our practices, patients and public health, including Medicare physician payment; utilization management/prior authorization; patient access to specialist-recommended therapies; and, penicillin allergy delabeling to improve patient outcomes, lower healthcare costs and help fight antimicrobial resistance. Find out more details shared during the visit.

•  AAAAI Pushes Back on New Drug-Pricing Models.
We submitted feedback on mandatory drug-pricing proposals; the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, and the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model. Our primary concerns on the models stem from potential negative impacts on Medicare beneficiaries with chronic allergic/immunologic conditions who rely on biologics. February 2026

•  Joining Response Call for Food Allergy Research, Prevention After FDA Labeling Meeting.
The FDA held listening sessions and an expert meeting on food allergy thresholds and labeling policy in February. We joined the Asthma and Allergy Foundation of America (AAFA) and others to call on the U.S. Department of Health and Human Services to take action to reduce the burden of food allergies on individuals and society through research-backed efforts focused on understanding, preventing and treating food allergies. Information on the workshop was posted May 6, 2026. March 2026

•  Proposed Changes to CDC’s Advisory Committee on Immunization Practice Charter Cause Major Concern.
We joined over 130 stakeholders in a joint statement condemning proposed changes to the Center for Disease Control’s (CDC) Advisory Committee on Immunization Practice (ACIP) Charter. The proposed charter, which would change the committee structure and focus, could significantly erode public faith in vaccines, unnecessarily increasing risk to patients with chronic health conditions. April 2026

•  ASTP/ONC’s HTI-5 Proposed Rule.
We submitted comments to the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) on its proposed rule HTI-5, expressing general support for efforts to modernize health IT certification and the transition from legacy Clinical Document Architecture (CDA) standards to Fast Healthcare Interoperability Resources (FHIR)-based approaches. While emphasizing the importance of maintaining robust antibiotic use and antimicrobial resistance reporting to support public health surveillance, we also highlighted the widespread mislabeling of penicillin allergies in electronic health records (EHRs) and urged ASTP/ONC to ensure that certification criteria leverage these FHIR-based standards to support accurate allergy documentation and delabeling of patients who are not truly penicillin allergic. February 2026

•  AAAAI Endorses Legislation to Expand Rural Telehealth Access.
Access to telehealth services removes geographical barriers, improves continuity of care and allows patients access to more physicians, saving practices both time and money. Congress recently expanded Medicare telehealth flexibilities through 2027, and on February 9, Representatives Chris Pappas (D-NH) and Zach Nunn (R-IA) reintroduced the Protecting Rural Telehealth Access Act (HR 7444). This bill would provide payment-parity for audio-only health services for clinically appropriate appointments, permanently waive certain geographic restrictions on telehealth services and expand originating sites to include the home and other sites. We support this bill. February 2026

•  Xolair Selected for Drug Price Negotiations.
The Centers for Medicare and Medicaid Services (CMS) announced the selection of Xolair for inclusion in the third cycle of the Medicare Drug Price Negotiation Program (MDPNP), with negotiated Maximum Fair Prices (MFPs) effective with Initial Price Applicability Year (IPAY) 2028. CMS is expected to finalize and publish MFPs following negotiations with manufacturers in 2026, ahead of the January 1, 2028, effective date. This fact sheet provides additional information on IPAY 2028, and more information on the MDPNP can be found on CMS’ website. January 2026

•  Air Pollutant Monitoring, Prevention of Poor Health Outcomes.
The Public Health Air Quality Act (S.3529) would require Environmental Protection Agency (EPA) to deploy fenceline air quality monitoring for pollutants contributing to poor health outcomes, including asthma, across vulnerable populations. We wrote to congress voicing our support for this legislation. January 2026

•  Whole Milk for Healthy Kids Act of 2025.
The Whole Milk for Healthy Kids Act of 2025 (S. 222), is expected to be signed into law. The legislation ensures the inclusion of “the best practices to prevent, recognize and respond to food-related allergic reactions” in training modules for local food service personnel. We provided technical input and sustained advocacy on S.1469 for four years, including as an original supporting organization and providing substantive comments to strengthen the legislation in close collaboration with the office of Senator Richard Durbin (D-IL). January 2026

•  We Urge Congress to Support Science on Childhood Vaccine Schedule.
We joined 230 national medical societies urging members of Congress to conduct a swift and robust oversight regarding the abrupt changes to the U.S. childhood vaccine schedule announced by the Centers for Disease Control and Prevention (CDC). This builds upon recent AAAAI action to encourage state governments to follow the AAP’s childhood immunization recommendations and a congressional letter led by the most recent recipient of the AAAAI’s Advocacy Award, Rep. Kim Schrier (D-WA), denouncing CDC’s recent decision to alter the childhood vaccine schedule recommendations. January 2026

•  Antimicrobial Resistance is a Growing Threat that Must be Mitigated.
We joined an effort in writing to Department of Health and Human Services Secretary Robert F. Kennedy Jr. about the importance of combatting antimicrobial resistance (AMR). We support the call for a meeting of the President’s Advisory Council on Combatting Antimicrobial Resistance (PACCARB). This council is meant to meet regularly to help ensure that the U.S. government programs and policies to combat AMR are as effective and efficient as possible. January 2026

•  Early Introduction Included in Dietary Guidelines.
The United States Department of Agriculture’s ’25-30 Dietary Guidelines for Americans includes a recommendation for early introduction of allergenic foods in infancy, a development that is both evidence-based and critical to allergy prevention. The updated guidelines suggest that infants at higher risk for a peanut allergy especially should undergo early introduction. We support early introduction in accordance with established clinical guidelines. January 2026

•  Legislation to improve asthma care.
The Elijah E. Cummings Family Asthma Act (H.R.6052), bipartisan legislation that expands the CDC’s National Asthma Control Program (NACP) to all 50 states to better educate families on asthma management and prevention is important. These programs are expected to help prevent negative health outcomes and ensure access to tools that prevent hospitalization the we pushed congress to pass this bill. December 2025

•  Advocating for Prior Authorization & Step Therapy Reform.
The bipartisan Improving Seniors’ Timely Access to Care Act would streamline and modernize the prior authorization process for Medicare Advantage plans. We along with other AMA Federation members are pushing for its passage. Prior authorization is one of the largest sources of care delays and administrative burden for physicians and their patients and needs reformation. December 2025

•  Anthem policy threatening physicians and patients.
Anthem Blue Cross Blue Shield recently announced a policy wherein hospitals will face a 10% reimbursement cut when out-of-network physicians provide care. This policy would compromise the financial viability of many independent physicians who require access to hospitals to provide care as well as increasing hospital costs. We joined other community stakeholders in calling for this policy’s immediate removal. November 2025

• Congress must pass a long-term Medicare Telehealth extension.
Millions of Medicare beneficiaries rely on telehealth services. Congress has previously extended flexibilities immediately prior to looming deadlines, but this year’s lapse in COVID-era extensions led to care disruptions for patients and clinicians. To prevent further lapses in care, we joined over 450 stakeholders in advocating for Congress to enact a long-term extension. November 2025

• Supporting Patient Access to Care and PBM Reform.
Pharmacy Benefit Manager (PBM) policies frequently disrupt patient access to essential medications. We have a long history of advocating for PBM reform policies, and recently urged congress to advance meaningful reforms before the end of the calendar year. November 2025

• Barriers to physician-led hospitals interfere with improved quality.
The Patient Access to Higher Quality Health Care Act of 2025 (H.R.4002) would eliminate statutory and regulatory barriers that prevent the development of physician-owned hospitals. Physician-owned hospitals may increase patients’ options for healthcare services, driving down costs and boosting innovation. We joined the AMA and other stakeholder organizations in supporting this legislation. November 2025

• The fight for coverage of medically necessary nutrition support.
The Medical Foods and Formulas Access Act of 2025 (H.R.5684) would start national coverage for people with medically necessary nutrition needs like those who have digestive or inherited metabolic disorders, including food allergies. We wrote to Congress in support of the bill. November 2025

• AAAAI-led penicillin allergy bill would improve patient outcomes, drive down costs, fight AMR and promote the allergy / immunology specialty.
The AAAAI-led Penicillin Allergy Verification and Evaluation Act (H.R. 5736) has been reintroduced in the U.S. House of Representatives by Representative Morgan Griffith (R-VA), Chairman of the House Energy and Commerce Subcommittee on Health, and six co-sponsors. This bill adds penicillin allergy delabeling to intake and annual exams for Medicare patients. We shared stakeholder support with congressional offices, inviting them to cosponsor the legislation and offering the AAAAI Penicillin Allergy Center. October 2025

• Prior authorization reform proposals raise concerns.
CMS is would like to reform the prior authorization process to address lack of transparency and wide variation between plans. However, recent industry proposals would shift coverage information exclusively to the physician practice’s back office and create payer- and vendor-specific companion guides. We voiced our concerns, calling for a restated commitment to a unified, standards-based solution that will reduce administrative burden, improve interoperability and ensure patients receive timely access to care. October 2025

• Programs to keep America’s children healthy.
To help improve the detection, intervention, research and awareness of congenital cytomegalovirus, we prompted congressional legislators to support the Stop CMV Act (H.R. 5435/S. 2842).

Similarly, we urged legislators to support funding for newborn screening programs through legislation like the Newborn Screening Saves Lives Reauthorization Act of 2025 (H.R. 4709). October 2025

• Support for school vaccine requirements.
To protect the health and safety of children and adults with asthma and immunodeficiencies, we sent a letter to the states urging them to follow the American Academy of Pediatrics' recommended vaccination schedule if they have not yet adopted a policy on school-entry vaccinations. We sent a letter of thanks to the few states (HI, RI, and VA) that already follow those recommendations. September 2025

• Removing harmful barriers to care.
In an effort to require health plans to improve transparency on and provide exceptions for step therapy, we are again supporting the Safe Step Act (H.R.5509/S.2903). This bill is endorsed by over 200 community stakeholder groups and would support vulnerable patient populations. September 2025

• Support for bill to cap epinephrine prices.
We sent a letter of support to Representatives Maxwell Frost (D-FL) and Doris Matsui (D-CA), the sponsors of the Epinephrine’s Pharma Inflated Price Ends Now Act, which would cap the cost of epinephrine through insurance. September 2025

• Advanced premium tax credits support coverage for millions.
Advanced premium tax credits (APTCs) have made health coverage more affordable for more than 24 million Americans, many of whom will lose coverage if these credits expire. We joined the American Medical Association (AMA) and other community stakeholders in asking Congress to extend the enhanced APTCs. September  2025

• We need action to preempt a physician shortage.
The Association of American Medical Colleges projects a physician shortage of up to 86,000 primary care and specialty doctors by 2036. To combat this shortage, we joined the Graduate Medical Education (GME) Advocacy Coalition to support the Resident Physician Shortage Reduction Act (S. 2439/H.R. 4731). September 2025

• Medicare Advantage patients’ access important across specialties.
To protect Medicare beneficiaries’ access to care and address Medicare Part B payment cuts, we joined the Part B Access to Seniors and Physicians Coalition in endorsing the bipartisan Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299). September 2025

• Dillon’s Law would provide training and access to help save lives.
We continue to support Dillon’s Law (H.R.4564). This bill encourages states to expand epinephrine training programs. Wisconsin, Indiana and Minnesota have already established similar laws. August  2025

• AAAAI supports the SPARC Act for rural access to specialists.
We have endorsed the Specialty Physicians Advancing Rural Care (SPARC) Act (H.R.4681 / S. 1380), a bipartisan bill to create a new student loan repayment program to motivate specialists in training, including those in allergy / immunology, to practice in rural communities for at least six years. August 2025

• Telehealth extension deadline looms.
To keep access to Medicare telehealth services, which will expire on September 30, the we joined 343 other community stakeholders in urging congress to preserve access to these services for a minimum of two years. August 2025

8/11/2026