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

Q1 Medicine Current Gastroenterology Reports Pub Date : 2024-03-01 Epub Date: 2024-01-20 DOI:10.1007/s11894-024-00916-w
Natalie Whitmire, Michelle Schlueter, Melissa Kirkpatrick
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Abstract

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. 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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炎症性肠病的先进疗法:应对支付方和财务挑战。
审查目的:在美国,克罗恩病和溃疡性结肠炎这两种最常见的炎症性肠病的治疗费用是影响治疗进程的主要因素。越来越多地使用生物制剂和口服小分子药物等先进疗法是造成这些费用的原因之一。许多 IBD 医疗服务提供者发现,在护理管理中,如何应对支付方和非保险费用援助流程是一项重大挑战。我们的目标是澄清这些流程,并提供成功的大纲:保险公司使用各种流程来管理药物费用,虽然这些流程最终可能并不具有成本效益,但这些流程一直在延续,而且越来越复杂。这种复杂性导致了可衡量的医疗延误和负面结果。随着对支付方和非保险成本援助流程的深入了解,我们开发出了一套工作流程,用于引导在治疗 IBD 时使用先进疗法。
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来源期刊
Current Gastroenterology Reports
Current Gastroenterology Reports Medicine-Gastroenterology
CiteScore
7.80
自引率
0.00%
发文量
19
期刊介绍: As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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