Variations in Health Insurance Policies Regarding Biologic Therapy Use in Inflammatory Bowel Disease

Inflammatory Bowel Diseases
Abhijeet YadavJoseph D Feuerstein

Abstract

The American Gastroenterological Association (AGA) has developed guidelines for the management of ulcerative colitis and Crohn's disease (CD) recommending anti-TNF therapy in moderate-severe disease. However, which drug is used is often dictated by insurance company policies. We sought to determine the insurance policy requirements prior to approval of biologic therapies. Using the National Association of Insurance Commissioners report of the top 125 insurance companies by market share in 2014, we reviewed the first 50 that had online policies regarding anti-TNF and vedolizumab available. Policies were reviewed for criteria needed for approval of anti-TNF or vedolizumab therapy, and for compliance with the current AGA clinical pathway recommendations. Ninety-eight percent of policies are inconsistent with the AGA ulcerative colitis pathway and require step-wise drug failure before approval of an anti-TNF. Only 11% of the policies allowed starting vedolizumab without initial failures of an anti-TNF agent, and 21% required the failure of two or more anti-TNF agents. Ninety percent of the policies are inconsistent with AGA CD pathway and require step-wise drug failure before approval of an anti-TNF. Seventy-four percent allowed fo...Continue Reading

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Citations

May 10, 2018·Journal of Crohn's & Colitis·Chung Sang TseKonstantinos A Papadakis
Jan 3, 2019·Inflammatory Bowel Diseases·Chenthan KrishnakumarSubra Kugathasan
Dec 24, 2018·British Journal of Clinical Pharmacology·Benjamin NemozFrançoise Stanke-Labesque
Apr 2, 2019·Inflammatory Bowel Diseases·Dana Rachel BergRyan Ungaro
Nov 16, 2018·Journal of Clinical Gastroenterology·Abhijeet YadavJoseph D Feuerstein
Feb 13, 2019·Inflammatory Bowel Diseases·Shubha BhatFrancis A Farraye
Jul 26, 2018·Arquivos De Gastroenterologia·Daniéla Oliveira MagroClaudio Saddy Rodrigues Coy
Jun 28, 2018·The American Journal of Gastroenterology·Neeraj NarulaParambir S Dulai
Sep 14, 2020·Journal of Digestive Diseases·Saurabh Talathi, Kondal R Kyanam Kabir Baig
Apr 13, 2021·Health Economics, Policy, and Law·Louis Tharp, Zoe Rothblatt
May 24, 2020·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Thomas Couri, Andrew Aronsohn
Sep 1, 2021·Digestive Diseases and Sciences·Amnon Sonnenberg, Gennadiy Bakis

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