How Physicians Can Help Patients With Crohn's Disease Navigate Insurance Delays and Denials
06/21/22 • 23 min
1 Listener
Drs Peter Higgins and Frank Scott discuss the challenges of delays in care for patients with Crohn's disease, how insurance denials and delays harm patients, and what doctors can do to help.
Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/967624). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.
Resources
Specialty Drug Coverage Varies Across Commercial Health Plans in the US https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1553
2021 AMA Prior Authorization (PA) Physician Survey https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918923/
Increased Risk of Venous Thromboembolic Events With Corticosteroid vs Biologic Therapy for Inflammatory Bowel Disease https://www.cghjournal.org/article/S1542-3565(14)01045-3/fulltext
Impact of Prior Authorization of Antiepileptic Drugs in Children With Epilepsy https://www.pedneur.com/article/S0887-8994(18)30151-6/fulltext
Prior Authorization Delays Biologic Initiation and Is Associated With a Risk of Asthma Exacerbations https://pubmed.ncbi.nlm.nih.gov/33404389/
Treatment Delays Associated With Prior Authorization for Infusible Medications: A Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062557/
Delays Related to Prior Authorization in Inflammatory Bowel Disease https://publications.aap.org/pediatrics/article/149/3/e2021052501/184867/Delays-Related-to-Prior-Authorization-in
What Is the Role of Fecal Calprotectin Levels in the Diagnosis of Inflammatory Bowel Disease (IBD)? https://www.medscape.com/answers/179037-54913/what-is-the-role-of-fecal-calprotectin-levels-in-the-diagnosis-of-inflammatory-bowel-disease-ibd
Variation In Use and Content of Prescription Drug Step Therapy Protocols, Within and Across Health Plans https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00822?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
What Is Step Therapy/Fail First? https://www.crohnscolitisfoundation.org/get-involved/be-an-advocate/steptherapy
H.R. 2163 – Safe Step Act https://www.congress.gov/bill/117th-congress/house-bill/2163
Step Therapy's Balancing Act — Protecting Patients While Addressing High Drug Prices https://www.nejm.org/doi/10.1056/NEJMp2117582?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Battle Heats up Over Bill on "Step Therapy," Drug Rebates https://www.coloradopolitics.com/legislature/battle-heats-up-over-bill-on-step-therapy-drug-rebates/article_0f6e56c4-c0b8-11ec-9ead-47fa6f99ac6e.html
Crohn Disease Pathology https://emedicine.medscape.com/article/1986158-overview#a6
Drs Peter Higgins and Frank Scott discuss the challenges of delays in care for patients with Crohn's disease, how insurance denials and delays harm patients, and what doctors can do to help.
Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/967624). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.
Resources
Specialty Drug Coverage Varies Across Commercial Health Plans in the US https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1553
2021 AMA Prior Authorization (PA) Physician Survey https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918923/
Increased Risk of Venous Thromboembolic Events With Corticosteroid vs Biologic Therapy for Inflammatory Bowel Disease https://www.cghjournal.org/article/S1542-3565(14)01045-3/fulltext
Impact of Prior Authorization of Antiepileptic Drugs in Children With Epilepsy https://www.pedneur.com/article/S0887-8994(18)30151-6/fulltext
Prior Authorization Delays Biologic Initiation and Is Associated With a Risk of Asthma Exacerbations https://pubmed.ncbi.nlm.nih.gov/33404389/
Treatment Delays Associated With Prior Authorization for Infusible Medications: A Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062557/
Delays Related to Prior Authorization in Inflammatory Bowel Disease https://publications.aap.org/pediatrics/article/149/3/e2021052501/184867/Delays-Related-to-Prior-Authorization-in
What Is the Role of Fecal Calprotectin Levels in the Diagnosis of Inflammatory Bowel Disease (IBD)? https://www.medscape.com/answers/179037-54913/what-is-the-role-of-fecal-calprotectin-levels-in-the-diagnosis-of-inflammatory-bowel-disease-ibd
Variation In Use and Content of Prescription Drug Step Therapy Protocols, Within and Across Health Plans https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00822?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
What Is Step Therapy/Fail First? https://www.crohnscolitisfoundation.org/get-involved/be-an-advocate/steptherapy
H.R. 2163 – Safe Step Act https://www.congress.gov/bill/117th-congress/house-bill/2163
Step Therapy's Balancing Act — Protecting Patients While Addressing High Drug Prices https://www.nejm.org/doi/10.1056/NEJMp2117582?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Battle Heats up Over Bill on "Step Therapy," Drug Rebates https://www.coloradopolitics.com/legislature/battle-heats-up-over-bill-on-step-therapy-drug-rebates/article_0f6e56c4-c0b8-11ec-9ead-47fa6f99ac6e.html
Crohn Disease Pathology https://emedicine.medscape.com/article/1986158-overview#a6
Previous Episode
Are We Any Closer to Intestinal Gene Therapy in Crohn's Disease?
1 RecommendationsDrs Peter Higgins and Judy Cho discuss recent success in sickle cell anemia and whether we're any closer to using intestinal gene therapy in Crohn's disease. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/967621). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.
Resources
Sickle Cell Anemia https://emedicine.medscape.com/article/205926-overview
Crohn's Disease https://emedicine.medscape.com/article/172940-overview
Inflammatory Bowel Disease https://emedicine.medscape.com/article/179037-overview
CRISPR-Cas systems: Overview, Innovations and Applications in Human Disease Research and Gene Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508700/
CRISPR-Cas9 Gene Editing for Sickle Cell Disease and β-Thalassemia https://www.nejm.org/doi/full/10.1056/NEJMoa2031054
Biologic and Clinical Efficacy of LentiGlobin for Sickle Cell Disease https://www.nejm.org/doi/10.1056/NEJMoa2117175
Causes of Crohn's disease https://medlineplus.gov/genetics/condition/crohn-disease/#causes
IL-10R Polymorphisms Are Associated With Very-Early-Onset Ulcerative Colitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744177/
Characterization of Crohn Disease In X-Linked Inhibitor of Apoptosis-Deficient Male Patients and Female Symptomatic Carriers https://pubmed.ncbi.nlm.nih.gov/24942515/
A Frameshift Mutation in NOD2 Associated With Susceptibility to Crohn's Disease https://www.nature.com/articles/35079114
Extended Haplotype Association Study in Crohn's Disease Identifies a Novel, Ashkenazi Jewish-Specific Missense Mutation in the NF-κB Pathway Gene, HEATR3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785105/
Autologous Stem Cell Transplant for Crohn's Disease https://www.mountsinai.org/clinical-trials/autologous-stem-cell-transplant-for-crohns-disease
Stem-Cell Transplantation for Crohn's Disease: Same Authors, Different Conclusions? https://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30076-6/fulltext#%20
A Myeloid-Stromal Niche and gp130 Rescue in NOD2-Driven Crohn's Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284870/
Expression of NOD2 in Paneth Cells: A Possible Link to Crohn's Ileitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773866/
Role of ATG16L, NOD2 and IL23R in Crohn's Disease Pathogenesis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270503/
Next Episode
Anti–interleukin-23 Medications and Durable Remission for Patients With Crohn's Disease
Drs Peter Higgins and Raja Atreya discuss the phenomenon of durable drug free remission in a subset of patients with Crohn's disease and the future of intermittent induction and sequencing of therapies.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/967625). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.
Resources
Efficacy and Safety of Mirikizumab in a Randomized Phase 2 Study of Patients With Crohn's Disease https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(21)03725-2
Long-Term Safety and Efficacy of Risankizumab Treatment in Patients with Crohn's Disease: Results from the Phase 2 Open-Label Extension Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684487/
Five-Year Efficacy and Safety of Ustekinumab Treatment in Crohn's Disease: The IM-UNITI Trial https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(21)00203-2
Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease https://www.nejm.org/doi/full/10.1056/NEJMoa1602773
Risankizumab as Induction Therapy for Crohn's Disease: Results from the Phase 3 ADVANCE and MOTIVATE Induction Trials https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00467-6/fulltext
Risankizumab as Maintenance Therapy for Moderately to Severely Active Crohn's Disease: Results from the Multicentre, Randomised, Double-Blind, Placebo-Controlled, Withdrawal Phase 3 FORTIFY Maintenance Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00466-4/fulltext
A37 Efficacy and Safety of Risankizumab as Maintenance Therapy in Patients With Crohn's Disease: 52 Week Results From the Phase 3 Fortify Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8859234/
Th17 Cells in Inflammatory Bowel Disease: Cytokines, Plasticity, and Therapies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846404
Expansion of IL-23 Receptor Bearing TNFR2+ T Cells Is Associated With Molecular Resistance to Anti-TNF Therapy in Crohn's Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580782/
Comparative Efficacy and Safety of Biologic Therapies for Moderate-to-Severe Crohn's Disease: A Systematic Review and Network Meta-analysis https://linkinghub.elsevier.com/retrieve/pii/S2468-1253(21)00312-5
European Crohn's and Colitis Organisation https://www.ecco-ibd.eu/
Mercaptopurine Therapy and TPMT and NUDT15 Genotype https://www.ncbi.nlm.nih.gov/books/NBK100660/
If you like this episode you’ll love
Episode Comments
Generate a badge
Get a badge for your website that links back to this episode
<a href="https://goodpods.com/podcasts/medscape-indiscussion-crohns-disease-205124/how-physicians-can-help-patients-with-crohns-disease-navigate-insuranc-21555377"> <img src="https://storage.googleapis.com/goodpods-images-bucket/badges/generic-badge-1.svg" alt="listen to how physicians can help patients with crohn's disease navigate insurance delays and denials on goodpods" style="width: 225px" /> </a>
Copy