Whitmire Natalie, Schlueter Michelle, Kirkpatrick Melissa
Division of Gastroenterology, UC San Diego Health, 9350 Campus Pt Dr Ste 2B, La Jolla, CA, 92037, USA.
Curr Gastroenterol Rep. 2024 Mar;26(3):68-76. doi: 10.1007/s11894-024-00916-w. Epub 2024 Jan 20.
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.
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.
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管理成本，是可能改变治疗进程的一个主要因素。生物制剂和口服小分子药物等先进疗法使用的增加是这些成本的一个驱动因素。许多炎症性肠病医疗服务提供者发现，在护理管理中应对付款方和非保险费用援助流程是一项重大挑战。我们旨在阐明这些流程并提供成功指南。
保险公司采用各种流程来管理药物成本，虽然这些流程最终可能不具有成本效益，但仍在持续且日益复杂。这种复杂性导致了可衡量的护理延误和负面结果。通过更深入地了解付款方和非保险费用援助流程，我们制定了一个在炎症性肠病治疗中使用先进疗法的工作流程。
