Insurance Companies' Poor Adherence to Guidelines for Moderate-to-Severe Ulcerative Colitis/Crohn's Disease Management

Am J Gastroenterol. 2024 Mar 15. doi: 10.14309/ajg.0000000000002720. Online ahead of print.

Abstract

Introduction: Moderate-to-severe inflammatory bowel disease treatment transitioned from step-up therapy to induction of remission with a biologic agent, but insurance coverage varies.

Methods: Top 50 insurance companies were searched for publicly available policies for 5 biologic/small molecule agents. Data regarding coverage requirements were compared with American College of Gastroenterology/American Gastroenterological Association guidelines.

Results: Thirty-four insurers had public policies. Adherence to American College of Gastroenterology/American Gastroenterological Association guidelines ranged from 5.8% to 58.8%. Only 14.71% and 17.65% of policies permitted any first-line biologic therapy in Crohn's disease and in ulcerative colitis.

Discussion: Nearly every insurance company required failure of steroids and immunomodulators before biologic therapy. Further work is required to improve patient access to standard-of-care treatment.