The Costs of Inflammatory Bowel Disease and the Financial Impact of Insurance Delays

ABSTRACT: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal disorders with systemic manifestations for which highly effective therapies and better understanding of treatment targets have transformed patient care. Owing to the low mortality and frequent early onset, as well as increasing prevalence of IBD, most patients are living with their disease for decades. Presently, proactive use of treat-to-target approaches aimed at endoscopic outcomes and integration of steroid-sparing advanced therapies have become a cornerstone of IBD management, with the intent to optimize patient outcomes and achieve remission. However, the substantial costs tied to research, development, and intricate manufacturing have resulted in advanced therapies being costly, leading to widespread implementation of a complex and nonstandardized prior authorization (PA) process. The heterogeneity in policies, coverage exclusions, and standard procedures across insurers makes the PA navigation process labor-intensive, costly, and time-consuming, and does not always result in consistent favorable outcomes or coverage for patients. In addition, insurer-related treatment delays have been associated with adverse clinical outcomes and increased absenteeism. Furthermore, PA denials often lead to the use of nonpreferred agents lacking evidence of clinical benefit. This review will attempt to summarize the costs related to IBD, assess how delays related to the PA process and administrative processes contribute to both direct and indirect cost burdens, and identify strategies that can potentially reduce overall costs in both pediatric and adult IBD care.