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Insurer-Mandated Medication Utilization Barriers are Associated With Decreased Insurance Satisfaction and Adverse Clinical Outcomes: An Inflammatory Bowel Disease Partners Survey.
Constant, Brad D; Long, Millie D; Scott, Frank I; Higgins, Peter D R.
Afiliación
  • Constant BD; Department of Pediatrics, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA.
  • Long MD; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • Scott FI; Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Higgins PDR; Department of Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA .
Am J Gastroenterol ; 119(10): 2070-2078, 2024 Oct 01.
Article en En | MEDLINE | ID: mdl-38819004
ABSTRACT

INTRODUCTION:

Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and increase healthcare utilization, yet rarely alter the medication ultimately prescribed.

METHODS:

We conducted a survey within the IBD Partners longitudinal cohort to evaluate the frequency and patient-reported impacts of medication utilization barriers on insurance satisfaction and clinical outcomes. Barriers included medication denials, prior authorizations, and forced medication switches. Variables associated with insurance satisfaction, measured on a 1-7 Likert scale, were identified. The association between insurance-related barriers and downstream clinical outcomes (surgery, corticosteroid requirement, and disease activity) were evaluated.

RESULTS:

Two thousand seventeen patients (age 45 [interquartile range 34-58] years, 73% female) were included. Seventy-two percent experienced an insurer-mandated barrier, most commonly prior authorizations (51%). Fifteen percent were denied an IBD medication by their insurer, 22% experienced an insurance-related gap in therapy, and 8% were forced by their insurer to switch from an effective medication. Insurance satisfaction was negatively associated with medication denials, prior authorization-related delays, gaps in therapy, and high-deductible health plan coverage. In the year following the initial survey, several insurance barriers were linked to negative downstream clinical outcomes, including prior authorizations associated with corticosteroid rescue (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.25-4.00), forced medication switches associated with continued disease activity (OR 3.28, 95% CI 1.56-6.89), and medication denials associated with IBD-related surgery (OR 8.92, 95% CI 1.97-40.39).

DISCUSSION:

These data illustrate the frequency and negative impacts of insurer-mandated medication barriers on patients with IBD, including decreased insurance satisfaction and negative downstream clinical outcomes.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedades Inflamatorias del Intestino / Seguro de Salud Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedades Inflamatorias del Intestino / Seguro de Salud Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos