As Congress moves to increase scrutiny of vision benefit managers (VBMs) for what it considers to be anti-patient and anti-competitive practices, Sen. Chris Murphy (D-Conn.) has proposed a bill seeking to address a part of the issue.

The bill, shared exclusively with Hartford Business Journal, is called the Vision Lab Choice Act of 2024 and would prohibit insurance plans from requiring doctors to use labs owned by the insurer. That would give optometrists freedom to choose the lab they use, potentially lowering costs for both the patient and provider, Murphy said.

He noted that there are two dominant VBMs nationally that provide two-thirds of Americans with vision benefits: VSP Vision Care and EyeMed Vision Care. The American Optometrists Association (AOA) says approximately 200 million Americans have a vision benefits plan that provides preventive eye exams and materials such as glasses or contacts.

“Right now, VBMs control practically every part of the vision industry — the insurance plans, the manufacturers for frames and lenses, the vision labs — and they use that power to eliminate choice and drive up costs for doctors and patients,” Murphy said. “This bill would solve a small piece of that problem by making sure optometrists aren’t forced to use a VBM’s preferred vision lab.”

In November, Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Accountability, sent a letter to U.S. Attorney General Merrick Garland demanding documents from the Department of Justice to evaluate the effect on patients of the consolidation among VBMs and their vertical integration with manufacturers and retailers. 

The AOA is also seeking to reduce the power of VBMs, backing broader bills proposed in the House by Reps. Buddy Carter (R-Ga.) and Yvette Clarke, (D-N.Y.), and in the Senate by Sens. Joe Manchin (D-W.Va.) and Kevin Cramer (R-N.D.), that also seek to address the controlling practices of VBMs.

“Special legal treatment for and a lack of competition among vision benefit managers has led to costly, choice-limiting mandates being forced on patients and their doctors — leading to higher prices and less access to care for patients, while doctors face the tough choice of providing needed care to neighbors or keeping their practices viable,” the AOA said.

An aide to Murphy said the senator is aware of the other bills, but that his is a more “tailored piece” of legislation that is narrower in scope to specifically address the vertical integration of VBMs in the hope that it will be included in an end-of-year package in Congress.

The National Association of Vision Care Plans (NAVCP), which has 33 members, including VSP and EyeMEd, who combined insure approximately 66% (218 million) of all Americans in all 50 states and Puerto Rico, say their benefit plans “drive healthy vision behavior, including regular eye tests and up-to-date vision correction,” while helping to identify serious eye and chronic disease, such as diabetes and high blood pressure, ensuring a healthier workforce.

The NAVCP states on its website that its members’ benefits plans also control costs, “assuring its quality, both for the plan beneficiaries and the payor (typically, the employer or group).”

NAVCP declined to comment Friday on Murphy’s bill.

Dr. Brian Lynch, an optometrist in Branford, says the vision coverage market is “broken.”

"Two large, vertically integrated (VBMs) now dominate the market in our state and across the country — and they use that dominance to set prices and force doctors and patients to buy the goods they make and use the services they own, including optical laboratories,” Lynch said. 

He added that the Vision Lab Choice Act is based on a law that already exists in Connecticut, and will ensure that “that VBMs regulated at the federal level can no longer sidestep our state protections."

According to the AOA, while 45 states have enacted legislation addressing vision and/or dental plan abuses, roughly one-third to one-half of plans operating in any given state are able to sidestep state laws because they are federally regulated. 

“That is why a federal effort is now needed,” the AOA said.

Lynch supports Murphy’s bill, which he said will “prevent abusive VBMs from forcing patients and their doctors to use the optical labs owned by the VBM itself — helping to ease costs, significantly lessen wait times for finished prescription eyeglasses, and giving patients and their doctors the freedom to choose the lab that works best for them.”