Open AccessBarriers From Third‐Party Payers to Biologic Use in Pediatric Inflammatory Bowel Disease
Author(s) -
Lepus Chelsea A.,
Hyams Jeffrey S.
Publication year - 2022
Publication title -
jpgn reports
Language(s) - English
Resource type - Journals
ISSN - 2691-171X
DOI - 10.1097/pg9.0000000000000215
Subject(s) - medicine , inflammatory bowel disease , denial , dosing , orphan drug , intensive care medicine , medicaid , disease , family medicine , health care , bioinformatics , psychology , psychoanalysis , economics , biology , economic growth
Biologic agents are now standard of care in the treatment of inflammatory bowel disease (IBD). The ability to use biologics in clinical practice is in part dictated by insurance company policies. There is a long delay between adult and pediatric approval of biologic agents, and these therapies are often denied by third‐party payers for use in pediatric IBD patients. This study prospectively identified pediatric patients with IBD who were started on a biologic medication at our institution, and third‐party payer decisions were recorded. There were no denials in patients with Medicaid, but private payers frequently interfered with use of biologic agents. Reasons for denial are generally for use of a specific off‐label agent or dosing of an approved agent. These denials lead to delayed treatment, nonmedically sound changes in therapy, and increased administrative burden on providers.