Patients with IBD Often Require Hospitalization, Surgery While Waiting for Insurance to Approve Therapy

By Andrew John, MD /alert Contributor
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A significant proportion of patients with inflammatory bowel disease experience hospitalization and even surgery while waiting for their insurance companies to approve small molecule or biologic therapies for their condition, suggesting that time to approval must be shortened to improve outcomes in these patients, according to findings presented at the American College of Gastroenterology 2022 Annual Meeting.

“Advanced IBD therapies including biological agents (infliximab, adalimumab, ustekinumab, golimumab, certolizumab pegol, and vedolizumab) and oral inhibitors (tofacitinib and ozanimod) have become mainstays of treatment for moderate to severe Crohn’s disease and ulcerative colitis,” Sarah Glover, DO, of the University of Mississippi Medical Center, and colleagues wrote in an abstract of their presentation. “Although providers have anecdotal evidence that delays in insurance approval for these treatments might result in adverse outcomes, the rate of hospitalization and surgery during the prior approval process have not been formally evaluated.”

The researchers reviewed data on 182 patients with IBD treated at a single center between March 2019, and December 2021. All patients included in the study had a “complete data set” available, defined as information such as medication history, patient demographics, insurance status, disease variables, date of decision for medication, date of the start of therapy, and date of prior authorization, as well as clinical outcomes for patients during the authorization period.

Nearly two-thirds of patients (64.3%) had previously been treated with an advanced therapy for IBD. A mean of 43 days elapsed between the date of decision and the initiation of therapy. This reportedly included an average of 42 days for patients without insurance, 40 days for those with commercial insurance, 45 days for patients on Medicaid, and 49 days for those on Medicare.

During this interval, 14.3% of patients visited an emergency room. A reported 14.8% of patients were admitted to a hospital, and 8.2% were reported to have undergone bowel resection. Furthermore, the researchers emphasized in their findings that delays in the initiation of therapy occurred even when patients had a full-time IBD specialist.

“This data suggests that the time to advanced IBD therapy approval probably needs to be shortened so as to reduce [morbidity] in this patient population,” Glover and colleagues concluded. “Further study across multiple institutions will be necessary in order to better address this important issue.”


Disclosures: Glover declared financial ties to drugmakers. See abstract for details.

Photo Credit: Getty Images.

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