Insurance-mandated barriers linked to negative clinical outcomes in IBD care
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Key takeaways:
- Seventy-two percent of IBD patients experienced insurance-mandated barriers.
- Barriers included prior authorizations (51%), medication denials (15%) and step therapy requirements (11%).
LAS VEGAS — Medication denials, forced medication switches and prior authorizations were among insurance-mandated barriers associated with negative clinical outcomes among patients with inflammatory bowel disease, according to data.
“Over the past 10 to 15 years, the outcomes of IBD have changed a bit and with those have come some increasing costs of care,” Brad David Constant, MD, assistant professor of pediatric gastroenterology at Children’s Hospital Colorado, said at the Crohn’s & Colitis Congress. “These costs of care have been met by the payers and insurance companies to try and make sure that we are not having unnecessary costs in utilization of these medications.”
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Constant continued: “These barriers have been shown to delay care by up to 3 months, depending on the appeal required, and have been shown to be associated with some adverse clinical outcomes, including increased corticosteroid burden and an increase in inflammation markers.”
Using data from the 2018-2019 IBD Partners insurance survey, Constant and colleagues analyzed the frequency of insurer-mandated medication utilization barriers and how they affect insurance satisfaction and clinical outcomes. Barriers included medication denials, prior authorization delays, step therapy requirements, insurer-forced medication switches and gaps in biologic therapy.
Outcomes included IBD-related surgery, new steroid prescription, remission to active disease and continued disease activity within 1 year.
Researchers included 2,017 patients with IBD (median age, 46 years, 73% women), of whom 64% had Crohn’s disease, 34% had ulcerative colitis and 3% had unclassified IBD; median disease duration was 15 years. Eighty-seven percent of patients had private insurance and 13% had public insurance.
According to results, 72% of patients experienced insurer-mandated barriers, which were more common among those with public insurance (P = .005). The most common barriers were prior authorizations (51%), medication denials (15%), step therapy requirements (11%) and insurer-mandated medication switches (7%); gaps in therapy were experienced by 22%, with a median duration of 4 weeks.
Further, negative clinical outcomes in the year following survey administration were associated with any insurance barrier (OR = 1.92; 95% CI, 1.38-2.68), medication denial (OR = 1.95; 95% CI, 1.45-2.62), insurer-forced medication switch (OR = 2.61; 95% CI, 1.77-3.85) and prior authorization delay (OR = 1.72; 95% CI, 1.3-2.28).
Notably, medication denial was associated with a ninefold increased likelihood for IBD-related surgery, and forced medication switches were associated with a more than twofold increased likelihood of corticosteroid rescue, researchers reported.
“Next steps for this research are very important,” Constant concluded. “Looking at how these affect patients, trying to look at these prospectively and determine how we can help the Crohn’s and Colitis Foundation and the advocacy efforts across the country, people in Congress to help protect our patients from these barriers.”
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Constant BD, et al. Insurance-mandated medication utilization barriers are associated with decreased insurance satisfaction and adverse clinical outcomes: An IBD partners survey. Presented at: Crohn’s & Colitis Congress; Jan. 25-27, 2024; Las Vegas.
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