Administrative friction from payors—especially prior authorizations, formulary instability, and opaque coverage criteria—has reached a breaking point for gastroenterology practices, prompting the American Gastroenterological Association (AGA) to shift from advocacy alone to direct collaboration with national insurers.
Recognizing that legislative progress has stalled despite bipartisan awareness, AGA has begun engaging payors directly to understand their decision-making processes and identify pragmatic ways to reduce clinician burden while preserving appropriate utilization controls.
Since fall 2024, AGA leadership has held ongoing discussions with major insurers focused on streamlining prior authorization workflows, improving coding clarity, aligning medical policies with evidence-based GI guidelines, and exploring value-based gastroenterology models centered on outcomes rather than volume. These conversations have opened two-way communication channels, with payors gaining visibility into how clinical guidelines are developed and updated—and AGA gaining insight into the data and criteria that drive coverage decisions.