Prior Authorization for Ustekinumab Dose Escalation Negatively Affects Outcomes in Patients With Inflammatory Bowel Disease

Choi, David; Puangampai, Archariya; Rubin, David T.

doi:10.1177/10600280221080986

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…A recent review noted “PA requirements [from 2007 to 2019]…for immune disease therapies…have increased from 35–67%. There is a lack of evidence indicating cost-savings associated with the current PA system” [ 23 ]. One study found that the average time from agreeing to start a biologic to payor approval was 30.5 days [ 24 ].…”

Section: Insurance Processmentioning

confidence: 99%

Advanced Therapies for Inflammatory Bowel Disease: Navigating Payor and Financial Challenges

Whitmire,

Schlueter,

Kirkpatrick

2024

Curr Gastroenterol Rep

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Purpose of Review In the United Sates the cost of managing Crohn’s disease and ulcerative colitis, the two most common inflammatory bowel diseases, is a major factor that can alter the course of treatment. The increasing use of advanced therapies such as biologics and oral small molecules is a driver of these costs. Many IBD providers find navigating the payor and non-insurance cost assistance processes to be a significant challenge in care management. We aim to clarify these processes and provide an outline for success. Recent Findings Insurance companies use various processes to manage medication costs and while they may not ultimately be cost-effective, the processes have continued and are increasingly complex. This complexity has led to measurable delays in care and negative outcomes. Summary With a deeper understanding of payor and non-insurance cost-assistance processes we have developed a workflow for navigating the use of advanced therapies in the treatment of IBD.

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Section: Insurance Processmentioning

confidence: 99%

Advanced Therapies for Inflammatory Bowel Disease: Navigating Payor and Financial Challenges

Whitmire,

Schlueter,

Kirkpatrick

2024

Curr Gastroenterol Rep

View full text Add to dashboard Cite

show abstract

“…By combining this and others with patient preferences (eg, route of administration), clinical judgment and experience (eg, immunogenicity), as well as guidelines published by AGA, ACG, and ECCO, prescribers can have supporting evidence to gain insurance approval of the desired therapy without (too much) delay, an unfortunate circumstance in the American healthcare system that costs patients’ valuable time. 11 …”

mentioning

confidence: 99%

The Winning Line Up: Positioning Advanced Therapies for Ulcerative Colitis

Förster

2023

Crohn's &Amp; Colitis 360

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Prior Authorization for Ustekinumab Dose Escalation Negatively Affects Outcomes in Patients With Inflammatory Bowel Disease

Cited by 2 publications

References 8 publications

Advanced Therapies for Inflammatory Bowel Disease: Navigating Payor and Financial Challenges

Advanced Therapies for Inflammatory Bowel Disease: Navigating Payor and Financial Challenges

The Winning Line Up: Positioning Advanced Therapies for Ulcerative Colitis

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