The U.S. Preventive Services Task Force is facing increasing pressure from outside groups to recommend certain screenings, counseling and medications, according to former task force chairs. 

The culprit: A provision in the Affordable Care Act. It requires that when the task force recommends certain preventive services, they must be covered without copays or deductibles under new health insurance policies. 

{mosads}In an Annals of Internal Medicine article, its three authors — all former task force chairs — wrote it might be time to re-think that policy. They wrote that Mylan was allegedly lobbying to have the task force classify epinephrine auto-injectors in a way to guarantee coverage. But the pharmaceutical company isn’t the only one that’s lobbied the task force, two of the article’s authors told The Hill Extra, and that’s a problem. 

“The lobbying and, particularly political lobbying, becomes very distracting,” Virginia Moyer, a former task force chair and member, told The Hill Extra, “and it takes time and energy away from the important work that the taskforce does.”  

The past

Previously, the spotlight on the task force wasn’t as intense — even though it was still viewed, in Moyer’s words, as the “single most respected resource for guidelines about preventive services.” In particular, the Centers for Medicare and Medicaid Services, as well as those working in primary care (like internists and family practitioners), paid attention to its recommendations.

The task force is an independent, volunteer panel of national experts. They’re tasked with recommending preventive services that specifically help a patient before a disease occurs or detect and treat a disease before symptoms begin. 

The present

In the last six years, more eyes have been on the panel, and “there’s a pressure that exists that didn’t exist before this coverage link,” Michael LeFevre, one of the article’s authors told The Hill Extra.

For example, that pressure can come from disease-oriented advocacy groups or professional organizations. It can take the form of official channels or the more unofficial, such as direct emails to task force members. Moyer remembers a huge box of more than 1,000 letters, all identical but signed by different people, advocating for the task force to recommend a certain diagnostic tool. 

“It’s easy for me to surmise,” LeFevre said, “that people recognize that one of the legal loopholes that allows them to try to get coverage for something that they want to either have covered in general (think patient advocacy) or to sell (think industry), they see this as a way to try and make that happen.”

Though, he added, the task force does a good job of resisting lobbying efforts and evaluation recommendations based on science. 

In a statement, current task force chair Kirsten Bibbins-Domingo said that “coverage decisions are the domain of payers, regulators, and legislators, whereas our independent scientific process remains focused solely on the evidence about which preventive services are beneficial, despite outside attempts to influence our work.”

The future

The Annals of Internal Medicine article criticized Mylan for a “blatant attempt to twist the notion of prevention to get first-dollar coverage, specifically to deflect legitimate concerns about the dramatic and as of now indefensible increase in the cost of the device.”

It pointed to an article in The American Journal of Medicine stating that classifying epinephrine as a preventive medicine could “increase patient access, improve outcomes, and save lives.” Mylan provided funding and editorial support for the manuscript, according to the unedited manuscript accepted for publication. The company declined to comment.

The task force hasn’t received a nomination to consider the EpiPen, according to a statement from Bibbins-Domingo, the current task force chair. She noted that EpiPens, while providing a life-saving treatment, are prescribed to those who have severe allergies and, thus, aren’t a preventive service. 

Though the Affordable Care Act provision has its benefits, such as helping alleviating a financial barrier to preventive service, according to the former task force chairs, they used the Mylan effort to make the point that it might be time revisit the panel’s role. 

“We doubt that Mylan will succeed with these current efforts, but it attempts to violate the integrity of the process and thus distracts from the mission,” the authors of the Annals of Internal Medicine article wrote. “The American public is best served by an independent scientific process free from advocacy and political pressure. If the only way to assure such independence is to sever the direct linkage to coverage, then it may be time to consider that option. Perhaps it is time for the USPSTF to inform, but not determine, coverage.”

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