Curr Gastroenterol Rep. 2024 Jan 20. doi: 10.1007/s11894-024-00916-w.Online ahead of print.

Natalie Whitmire ¹, Michelle Schlueter ², Melissa Kirkpatrick ²

Author information

¹Division of Gastroenterology, UC San Diego Health, 9350 Campus Pt Dr Ste 2B, La Jolla, CA, 92037, USA. nwhitmire@health.ucsd.edu.

²Division of Gastroenterology, UC San Diego Health, 9350 Campus Pt Dr Ste 2B, La Jolla, CA, 92037, USA.

Abstract

Purpose of review: In the United Sates the cost of managing Crohn's disease and ulcerative colitis, the two most common inflammatory bowel diseases, is a major factor that can alter the course of treatment. The increasing use of advanced therapies such as biologics and oral small molecules is a driver of these costs. Many IBD providers find navigating the payor and non-insurance cost assistance processes to be a significant challenge in care management. We aim to clarify these processes and provide an outline for success.

Recent findings: Insurance companies use various processes to manage medication costs and while they may not ultimately be cost-effective, the processes have continued and are increasingly complex. This complexity has led to measurable delays in care and negative outcomes. With a deeper understanding of payor and non-insurance cost-assistance processes we have developed a workflow for navigating the use of advanced therapies in the treatment of IBD.