Today, the American Gastroenterological Association (AGA) published a white paper on the future of inflammatory bowel disease (IBD) care in the United States. AGA highlights the current barriers to care and calls for collaboration among our healthcare community, insurers, pharmaceutical companies and legislators to improve and optimize care for the more than three million Americans living with IBD.
IBD is a complex disease that requires a vigilant and coordinated multidisciplinary approach. Over the last two decades, there has been a revolution in therapeutics fueled by exciting research and development that continues to expand and evolve the treatment armamentarium for IBD, offering hope for better disease control. However, the most effective therapies for IBD are cost prohibitive and have become inaccessible due to insurer-mandated barriers to care such as prior authorization and step therapy.
AGA highlights seven barriers to care:
- Restricted access to treatment through prior authorization and step therapy
- Prohibitive drug costs
- Forced non-medical switching
- Coverage gaps in disease monitoring
- Inadequate coverage for multidisciplinary care
- Limited access to IBD specialists
- Intersecting identities leading to inequality
"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, MD, co-first author and IBD specialist at Oregon Health and Science University. "We must work together to collaborate on solutions to strengthen and advance the care for all people with IBD."
AGA's 12-point plan for the future of IBD care:
- The lived experiences and valuable insights from both patients and expert clinicians should be reflected in the data and research represented in the field.
- AGA recognizes the powerful benefit of individually tailoring IBD therapy based on risk, comorbidities and response and encourages all stakeholders to do the same.
- As a field, we need to move beyond insurer-mandated step therapy and fail first policies.
- AGA urges insurers to cover all necessary disease activity and drug level monitoring, which will ensure patients are able to achieve treat to target driven outcomes.
- Streamlined and expedited expert reviews should be guaranteed to all providers when they are mandated by an insurer.
- To ensure transparency and accountability, AGA wants to require that payors publish their denial and appeals data.
- AGA believes that holistic patient-centered multidisciplinary care, including psychosocial and dietary support, be covered by insurance. Having access to such care contributes to improved patient resilience and well-being which will lead to decreased healthcare utilization and better health outcomes.
- AGA supports the creation and continuation of a variety of patient education programs to improve health literacy and awareness of complex health care systems.
- AGA is committed to improving patients' access to expert specialized clinical IBD care. This includes flexible delivery models to ensure that underserved populations are being reached. In addition, AGA supports training and educating specialty providers across the spectrum of medical care (advanced practice providers, nurse educators, etc.) to increase the number of qualified IBD providers.
- Piloting innovative shared incentive partnerships between high value sub-specialty care practices and payors will be a new shared goal.
- AGA wants to engage pharmaceutical partners in developing equitable programs to address prohibitive drug costs while also expanding patient access and support.
- AGA plans to continue to advocate for legislation to make access to therapy equitable for Medicare and Medicaid patients.
AGA published this white paper online on Feb. 28, 2024, in Clinical Gastroenterology and Hepatology, and it will appear in the May 2024 print issue.
