Insurance Denial of Biologic Therapy is Associated With Reduced Remission Rates in Inflammatory Bowel Disease Patients

Background and Aims

Biologic therapy is indicated for patients with moderate to severe inflammatory bowel disease (IBD) and delays in access to these medications have been associated with higher health-care utilization. We examined whether patients who experienced insurance denials of biologics had worse outcomes, as indicated by disease activity and the number of emergency department (ED) visits and hospitalizations had following medication denial.

Methods

Our single-center retrospective cohort study included 169 patients with IBD who were seen at a tertiary care center (University of Maryland Medical Center) and had an insurance denial for biologic therapy between March 2021 and October 2021. Data were collected through chart review.

Results

At 6 months following denial, 58.0% of patients were in remission, 37.9% had active disease, and 4.1% had unknown status. Those who did not receive medication approval were significantly more likely to have active disease (Odds ratio = 0.16, 95% confidence interval = [0.04‒0.69] P = .042). Compared to patients in remission after delay in therapy initiation, those with active disease were likelier to receive steroids in the year following denial (38.5%, P < .001), trended toward higher likelihood of ED visits (P = .062), and had higher likelihood of hospitalization in that time (27.7% vs 8.2%, P = .002), with a higher number of average ED visits (P = .019) and hospitalizations (P = .003). Patients with active disease post denial had a nearly 80% increase in days between denial and final approval (P = .031).

Conclusion

Our study demonstrates an association between insurance denial of biologic therapy and lack of clinical remission with associated increased health-care utilization in IBD patients.