Delays Related to Prior Authorization in Inflammatory Bowel Disease

Abstract

BACKGROUND Delays in advancing to biologic therapies are associated with adverse outcomes in inflammatory bowel disease (IBD). Insurer-mandated prior authorizations have been linked to prolonged medication initiation times. We hypothesized that prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization among children with IBD. METHODS We performed a retrospective cohort study of 190 pediatric patients with IBD initiating biologics at a tertiary care hospital to measure the association between prior authorization, biologic initiation time (physician recommendation to first dose), and healthcare utilization (hospitalization, surgery, or emergency department visit). Demographic, insurance, and disease severity–related covariables were collected. Multivariable linear regression was used to measure the association between prior authorization and biologic initiation time. Propensity score methods were used to measure the associations between prior authorization and IBD-related healthcare utilization within 180 days and corticosteroid dependence at 90 days, with adjustment for insurance type, demographics, and disease severity–related characteristics. RESULTS Median biologic initiation time was 21 days. Prior authorization and complicated prior authorizations (requiring appeal, step therapy, or peer-to-peer review) were associated with 10.2-day (95% confidence interval [CI] 8.2 to 12.3) and 24.6-day (95% CI 16.4 to 32.8) increases in biologic initiation time, respectively. Prior authorizations increased the likelihood of IBD-related healthcare utilization within 180 days by 12.9% (95% CI 2.5 to 23.4) and corticosteroid dependence at 90 days by 14.1% (95% CI 3.3 to 24.8). CONCLUSIONS Prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization. Minimizing prior authorization–related delays may expedite biologic delivery and reduce the risk of IBD-related healthcare utilization.

Barriers From Third-Party Payers to Biologic Use in Pediatric Inflammatory Bowel Disease

“…Another recent study found that prior authorization and complicated authorizations requiring appeal, step therapy, or P2P were associated with 10.2- and 24.6-day increases in biologic initiation time, respectively. 11 In that same study, prior authorizations were associated with a 12.9% increased likelihood of IBD-related healthcare utilization within 180 days of biologic recommendation and a 14.1% increased likelihood of corticosteroid dependence at 90 days.…”

One Year Into Dupilumab: Physician and Patient Experiences in Initiating Dupilumab for Pediatric Eosinophilic Esophagitis

“…They also showed that complicated PA was associated with 24.6-day increase in biologic initiation time (13). Additionally, PA was associated with 12.9% increase likelihood of IBD-related health care utilization and 14.1% increased likelihood of corticosteroid dependence at 90 days, an important outcome measure in IBD (13). Patients with EoE have a high annual health care cost when compared to the general population, estimated at $1.4 billion in the United States (14).…”

Morroniside alleviates lipopolysaccharide-induced inflammatory and oxidative stress in inflammatory bowel disease by inhibiting NLRP3 and NF-κB signaling pathways

“…Inflammatory bowel disease signifies disorders involving chronic inflammation of the digestive tract, that is, a type of inflammatory disease that affects the rectum and colon. 1 The treatment mainly includes drug therapy and surgery. More effective drugs are to be developed to improve treatment effectiveness.…”

“…Inflammatory bowel disease (IBD) is a noninfectious, chronic, and recurrent inflammation of the gastrointestinal tract. 1,2 Common symptoms of IBD include diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss. 3,4 It is important to diagnose IBD.…”