Key Points:
- Most U.S. insurance companies require patients with Crohn’s disease and ulcerative colitis to fail conventional treatments like steroids and immunomodulators before they cover biologic therapy. This approach contradicts the current treatment guidelines.
- The treatment of moderate to severe IBD has shifted from step-up therapy to the first-line use of biologic agents for inducing remission. However, insurance coverage for this approach varies.
- Researchers reviewed policies from the 50 largest U.S. insurance companies regarding coverage for five biologic/small molecule agents. These policies were compared with the treatment guidelines from the American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG).