DOI: 10.14309/ajg.0000000000002720 ISSN: 0002-9270
Insurance Companies’ Poor Adherence to Guidelines for Moderate to Severe Ulcerative Colitis/Crohn’s Disease Management
Kelsey L. Anderson, Rajsavi Anand, Joseph D. Feuerstein- Gastroenterology
- Hepatology
Background:
Moderate-to-severe IBD treatment transitioned from step-up therapy to induction of remission with a biologic agent, but insurance coverage varies.
Methods:
Top 50 insurance companies were searched for publicly available policies for 5 biologic/small molecule agents. Data regarding coverage requirements were compared to ACG/AGA guidelines.
Results:
Thirty-four insurers had public policies. Adherence to ACG/AGA guidelines ranged from 5.8-58.8%. Only 14.71% and 17.65% of policies permitted any first-line biologic therapy in CD and in UC.
Discussion:
Nearly every insurance company required failure of steroids and immunomodulators before biologic therapy. Further work is required to improve patient access to standard of care treatment.