Anderson Kelsey L, Anand Rajsavi, Feuerstein Joseph D
Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.
Department of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California, USA.
Am J Gastroenterol. 2024 Mar 15. doi: 10.14309/ajg.0000000000002720.
Moderate-to-severe inflammatory bowel disease treatment transitioned from step-up therapy to induction of remission with a biologic agent, but insurance coverage varies.
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.
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.
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.
中重度炎症性肠病的治疗已从逐步治疗转变为使用生物制剂诱导缓解，但保险覆盖情况各不相同。
检索了排名前50的保险公司关于5种生物制剂/小分子药物的公开可用政策。将有关保险覆盖要求的数据与美国胃肠病学院/美国胃肠病学会指南进行了比较。
34家保险公司有公开政策。遵循美国胃肠病学院/美国胃肠病学会指南的比例在5.8%至58.8%之间。只有14.71%和17.65%的政策允许在克罗恩病和溃疡性结肠炎中进行任何一线生物治疗。
几乎每家保险公司都要求在生物治疗前先使用类固醇和免疫调节剂治疗失败。需要进一步努力，以改善患者获得标准治疗的机会。
