INSURER-MANDATED MEDICATION UTILIZATION BARRIERS ARE ASSOCIATED WITH DECREASED INSURANCE SATISFACTION AND ADVERSE CLINICAL OUTCOMES: AN IBD PARTNERS SURVEY

Abstract

Abstract BACKGROUND & AIMS Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and increase healthcare utilization, yet rarely alter the medication ultimately prescribed. Using the IBD Partners research network, we analyzed patient-reported impacts of these barriers on insurance satisfaction and clinical outcomes. METHODS We analyzed 2018-2019 IBD Partners insurance survey data to evaluate the frequency and impacts of medication utilization barriers on insurance satisfaction and clinical outcomes. Barriers included medication denials, prior authorizations, step therapy requirements, insurer-forced medication switches, and gaps in care. Stratified analyses measuring the frequency of these barriers were conducted among private versus public health plans. Variables associated with insurance satisfaction, measured on a 1-7 Likert scale, were identified. The association between insurance-related barriers and clinical outcomes (surgery, corticosteroid requirement, and disease activity) within one year of the initial survey were evaluated. RESULTS 2017 patients (Age 46 [IQR 34, 58], 73% female) were included. Sixty-four percent had Crohn’s Disease, 34% had ulcerative colitis, and 3% had IBD-Unclassified. Seventy percent had received a biologic, and 86% were corticosteroid-exposed. The median disease duration was 15 years (IQR 9, 25). Regarding insurance characteristics, 86% had private insurance (81% via their employer, 5% via Affordable Care Act) and 12% had public insurance (11% Medicare, 2% Medicaid). Insurer-mandated barriers to care were experienced by 72%, including prior authorizations (51%), medication denials (15%), step therapy requirements (11%), and insurer-forced medication switch (7%). These barriers were generally more common among those with public insurance (Figure 1). Sixty-two percent were at least somewhat satisfied with their insurer. Medication denials, prior authorization-related delays, gaps in therapy, and high-deductible health plan coverage were each uniquely associated with insurance dissatisfaction. Insurance barriers, medication denials, insurer-forced medication switches, and prior authorizations were each associated with negative clinical outcomes in the year following survey administration. Notably, medication denial was associated with a 9-fold increased likelihood of IBD-related surgery, and an insurer-forced medication switch was associated with a 2.5-fold increased likelihood of corticosteroid rescue. CONCLUSIONS Patients with IBD frequently experience insurer-mandated barriers to care which are associated with decreased insurance satisfaction and negative downstream clinical outcomes. Together, these data illustrate the negative impacts of insurer-mandated medication barriers on patients with IBD.