The month of May is a busy time for many practicing allergists. Many of our patients are feeling the effects of spring, and their allergy symptoms have been ramping up. National Asthma & Allergy Awareness Month, celebrated throughout the month of May, is a time when attention is focused on asthma and other allergic conditions. Examples of condition-specific observances include Food Allergy Awareness Week (May 10-16) and National Eosinophil Awareness Week (May 17-23).
The College is focused on the needs of our members who treat patients with these conditions throughout the year, not just during May. Commemorative months like National Asthma & Allergy Awareness Month, however, provide an opportunity for the College to direct its focus on resources and initiatives for our members and the public. We also provide great tools for you to use in helping to inform and educate your community. Read the article in today’s Insider for ways you can share your expertise.
Another part of raising awareness is making sure decision-makers in our government understand that millions of Americans are affected by allergic conditions and allergists’ care can bring them relief. The College’s StrikeForce is traveling to Washington, DC this week to meet with members of Congress and their staff. I’ll be among this group. We’ll be discussing priorities such as prior authorization, PBM reform, Medicare payments to physicians, funding for graduate medical education and more. Our StrikeForce, along with patients and representatives of the Allergy and Asthma Network, will team up in Washington to communicate important health care issues, such as accessibility and affordability. Do we expect action immediately? Not necessarily – but the intent is to forge, maintain, and strengthen relationships with legislators so our priorities remain at the forefront.
Our advocacy efforts have paid off. Recent wins include:
- The College and the Advocacy Council supported the Protecting Children with Food Allergies Act, which funds food allergy training for school food service staff. This bill was signed into law by President Trump in January.
- A recent Annals article reaffirms the scientific and economic foundations of allergen immunotherapy and another describes strategies to use when insurers ask for excessive patient records. We’ll be using these articles when we visit members of Congress this week and in our outreach to payers.
- Seven Medicare Administrative Contractors (MACs) have agreed to pay allergists for build-up as well as maintenance doses of allergenic extracts.
- The College’s Advocacy Council submitted comments on the Democratic and Republican Doc Caucus’s MACRA Modernization RFI. Our comments urged Congress to stabilize Medicare physician payments and address statuary and regulatory flaws in MIPS.
These are just a few examples of how the Advocacy Council is working for you. You can advocate for our specialty as well by being informed, heard, and involved.
The College is partnering with Congressman Bob Onder (R-MO) on the Allergy and Asthma Patient Protection Act (official introduction expected soon), which will address commercial payer reimbursement issues that threaten allergy practices across the country. This bill will soon be introduced by Rep. Onder, the only allergist in Congress. Priorities of the bill include:
- Require all health plans to adhere to the CPT definition of Code 95165 to ensure consistency in coverage and reimbursement.
- Prohibit denials for skin testing and spirometry when performed on the same day as an office visit. Current denial practices—often citing lack of “medical decision-making” or “interpretation” despite documentation—create unnecessary delays in care and added burdens for both patients and practices.
- Prohibit health plans from reducing or denying reimbursement for CPT Code 95165 when allergen extracts include diluent. The use of diluent is medically necessary to ensure safe dosing and avoid the administration of overly concentrated allergens.
- Require all health plans to cover the buildup phase of allergy immunotherapy as an essential component of treatment.
- Establish a more appropriate annual Medically Unlikely Edits (MUE) cap of no less than 150 units for CPT Code 95165, better reflecting real-world clinical practice compared to the current Medicare limit of 30 units per day.
The month of May brings awareness to allergic and immunologic conditions. But the College never stops the drumbeat of support for our members as you bring hope and relief to patients every day of the year. Please know that the College is working for you, the practicing allergist. I encourage you to take advantage of the College’s tools to engage in Awareness Month – whether it’s taking a few minutes to post about allergic conditions on social media, sending postcards to primary care practitioners in your community, or exploring ways to become involved in advocacy. I invite you to stay informed and become involved during National Asthma & Allergy Awareness Month and throughout the year.
