Issues in Optometry

The Pending Legislation Offering Protection to Both Doctors & Patients

Optometrist stands with his U.S. congressional representative and a colleague optometrist advocating for the passage of the Dental and Optometric (DOC) Access Act.

Dr. Layman with U.S. Representative Bob Latta and Lauren Haverly, OD. Dr. Layman says the Dental and Optometric (DOC) Access Act would improve the lives of both patients and optometrists.

By Robert C. Layman, OD
Immediate Past President, American Optometric Association (AOA)

August 2, 2023

There is pending legislation, the Dental and Optometric Care (DOC) Access Act, that stands to help both optometrists and patients. Here are the details, including what you can do to make passage of this bill more likely.

What is It?
The DOC Access Act targets ongoing abuses in the vision coverage industry and it seeks to empower patients and their doctors in a market that is growing increasingly consolidated, vertically integrated and rigged against them.

The legislation does a couple of things – it prohibits vision benefit managers from fixing prices for services and materials not covered by the plan and gives patients and their doctors the freedom to choose the lab that works best for them. The bill would also prevent plan-doctor contracts from lasting longer than two years, unless the doctor decided to opt out and keep the arrangement as is.

The legislation is needed because a substantial share of the vision coverage market in each state is regulated on the federal level. So, despite a growing number of states enacting strong anti-vision plan abuse laws, those state efforts can’t fix abuses among federally regulated plans – which can account for roughly half of patients in a given state – because of federal preemption.

Why Should ODs Support It?
Passage of DOC Access would be a huge win for patients and their doctors. Right now, the vision coverage market is highly concentrated and those top players use their market power to control doctor and patient behavior – often forcing us and our patients to buy the goods and use the services that the plan’s vertically integrated parent company makes and owns.

The DOC Access law would help restore some balance and give us and our patients greater control over what is best for us and our practices. On a larger level, the DOC Access Act would help spur more competition in the market, which should help encourage new entrants and force the dominant players to have to work to recruit and retain a happy provider network.

For individual practices, a new DOC Access law would mean that the plans could no longer use the contracting process to interfere in pricing structures or force doctors and patients to buy their products or use the materials and services they make and own, such as labs. I’m also confident that with more competition in the market, the dominant plans will be forced to reconcile with the inexcusable fact that vision plan reimbursements for eye exams have barely increased in absolute terms in three decades.

What Can ODs to Make Passage More Likely?
The momentum behind passing DOC Access has never been bigger and the environment to do so has never been better. No doubt, we have the wind at our back, but we’ll need more ODs and students to join the fight if we hope to have a shot at getting this over the finish line. That being said, we have some big things working in our favor. Congress is right now talking about consolidation in healthcare coverage and vertical integration among coverage providers.

A particular focus has been on pharmacy benefit managers, which behave similarly to vision plans. And Congress looks poised to pass pharmacy benefit managers (PBM) reform, which presents us with a real opportunity to hitch a ride. Our lead House sponsor of the DOC Access Act, Rep. Buddy Carter, who is a pharmacist, is a key player in those negotiations, but he needs our help building co-sponsor numbers right now.

We also have committed partners in the American Dental Association, and a growing number of patient advocacy group are backing the effort, including an influential group called Patients Rising, which has been circulating an explainer video on Capitol Hill urging passage of the DOC Access Act. With all that being said, it’s hard to know what priorities Congress will focus on in the near term, but we have to be ready with a high level of support if and when the spotlight turns to ending vision plan abuses.

The way for lawmakers to officially signal their support of an issue before Congress is to join on the bill as a co-sponsor. That’s what we now need – every U.S. Senator and House member to join as a co-sponsor of the DOC Access Act (HR 1385 in the House and S. 1424 in the Senate).

The easiest way to do that is though the AOA’s Online Action Center at or by texting DOC to 855-465-5124, and through just the click of a button, advocates can send a pre-populated letter directly their two senators and one House member right away. And after you do, urge at least three colleagues to do the same.

We’re fighting back and we’re winning, but we need many more ODs and students to join the fight and help us put an end to vision plan abuses by getting the DOC Access Act over the goal line!

Robert C. Layman, OD, is Immediate Past President of the American Optometric Association (AOA) and a partner with Pinnacle Eye Group in Lambertville, Mich., and Great Lakes Vision Care in Monroe Mich., both Vision Source practices.  To contact him:


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