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AGA Announces a 12-Point Plan to Adress Barriers to IBD Care

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Elimination of insurance-mandated step therapy and allowing the Medicare beneficiaries to use copay assistance programs are among the changes the American Gastroenterological Association (AGA) wants to see.

The goal of treatment for inflammatory bowel disease (IBD), including ulcerative colitis (UC), is to achieve and sustain remission. This requires coordinated efforts between a multidisciplinary team of experts, including gastroenterologists, surgeons, nurses, mental health professionals, dietitians and pharmacists.

The past two decades have afforded advances in IBD treatments that can slow or stop disease progression and minimize complications, such as the need for surgery, organ damage, and an increased risk of developing colorectal cancer. However, many new therapies come with a hefty price tag, and numerous barriers exist, rendering the most effective IBD treatments inaccessible to some patients.

In a white paper, which was recently published in Clinical Gastroenterology and Hepatology and to appear in the May 2024 print issue, the American Gastroenterological Association (AGA) highlights current barriers to care for people living with IBD and provides a 12-point plan to address these barriers and improve access to effective IBD therapies.

AGA delineates the following barriers to IBD care:

  • Restrictions in access to treatment due to prior authorization and step therapy policies
  • Prohibitive drug costs
  • Forced switching of medications and treatments by insurance companies without medical or patient participation
  • Coverage gaps in screening procedures, such as colonoscopies and fecal calprotectin evaluations
  • Insufficient coverage for multidisciplinary team members, such as nutritionists and mental health professionals
  • Limited access to IBD specialized care
  • Inequities leading to disparities in health outcomes for vulnerable groups of people with IBD, including Black and Hispanic patients and members of the LGBTQI+ community
2 people reviewing. a plan | Image credit: ©Andrew Popov   stock.adobe.com

With improved patient health and well-being as a guiding principle to develop policies that embrace high-value, multidisciplinary IBD care, AGA announced the following 12-step plan to improve access to care:

  1. Incorporate tailored treatment strategies based on risk, comorbidities and patient response.
  2. Insurers should cover necessary disease activity and drug level monitoring to achieve treat to target-based outcomes.
  3. Eliminate insurance-mandated step therapy and fail-first policies.
  4. Allow for the use of co-pay assistance programs with federal insurers, such as Medicare.
  5. Adopt a national standard for drug coverage benefits that includes a review of literature and guidelines, participation from subject experts and patients, and disclosure of conflicts of interest.
  6. Create national standards for the prior authorization appeals process.
  7. Insurers should guarantee expedited and streamlined expert reviews when they are mandated.
  8. Support a holistic multidisciplinary approach that includes dietitians, social workers, mental health providers and specialist nurses.
  9. Promote patient engagement and shared decision making to aid in attaining clinical remission, improve quality of life, and reduce the risk of anxiety and depression.
  10. Address health disparities and advocate for legislation that addresses social determinants of health, such as housing, employment and education.
  11. Embrace new care models that reduce cost while providing high quality care, such as the partnerships between the Crohn’s and Colitis Foundation and Cost Plus Drugs.
  12. Improve patient access to specialty care with alternative delivery methods, such as virtual IBD centers.

AGA emphasizes that changes in the current healthcare system could improve patient care effectiveness, efficiency, and equity.

“Unaffordable drug costs, step therapy, and other insurer-mandated barriers are fixable problems. Every day, we see people that have been harmed by delayed and inadequate care. Solving these barriers would lift an unimaginable weight off our patient’s shoulders and allow them to lead healthier lives,” said M. Anthony Sofia, M.D., co-first author of the white paper and IBD specialist at Oregon Health and Science University, in a press release.

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