Writing in GI & Hepatology News’ Practice Management toolbox, a group of GIs note that over the last several years, payer policies that dictate and restrict treatments for patients with inflammatory bowel diseases (IBD) have proliferated.
According to a recent survey of AGA members, an overwhelming majority reported that payer policies of prior authorization (PA), step therapy and non-medical switching have had a negative impact on patients’ access to clinically appropriate treatments. Reducing the burdens of these policies is a major priority for AGA advocacy.
Almost 99% of members indicated that PA has a negative impact on patients’ access to clinically appropriate treatments.
The authors, Drs. Joseph D. Feuerstein, M. Anthony Sofia, Sushovan Guha and Sarah Streett, highlight the following opportunities for insurers to improve the IBD drug approval process:
- Simplify the appeal process.
- Guarantee rapid response/turnaround to appeal processes to avoid additional delays in care.
- Incorporate experienced expert review by a gastroenterologist.
- Ensure coverage of drug and disease monitoring.
- Integrate expert input in policy development.