(418) Frequency and Impact of Insurance Changes Among IBD Patients Using Specialty Medications

Background: : There is a paucity of data describing the frequency of prior authorizations (PAs) and associated challenges that occur when patients with inflammatory bowel disease (IBD) established on specialty therapies switch insurance.

Objective: : This study describes the frequency of insurance changes and PA burden during the first 6 months of 2024 in adults receiving specialty medications for IBD through an integrated health system specialty pharmacy (HSSP).

Methods: : This retrospective cohort study included adults established on specialty therapy Jan 1, 2024, with prescriptions filled by the HSSP. Therapy was established if ≥2 fills occurred from Sept-Dec 2023 or one fill during that time and one in Jan–March 2024. Data from Jan-June 2024 was reviewed. Primary outcome was frequency and timing of insurance changes. Secondary outcomes were the number of PAs, medication changes, and therapy discontinuations due to insurance in patients with and without insurance changes. Descriptive statistics summarized the data. An ordinal logistic regression model evaluated the association between insurance change and the number of PA's needed.

Results: : Included patients (n=883) were White (89.2%), female (59.7%), commercially insured (74.5%) with a median (interquartile range) age of 43 (32-55) years. From Jan-June 2024, 122 patients (13.8%) had at least one insurance change. Three had multiple changes. Over half occurred in January (55.2%). Overall, 604 PAs were completed; 103 (17.1%) were related to insurance changes. Patients with insurance changes had 5.5 times greater odds of requiring more PAs compared to those without changes (OR 5.5, 95% CI 3.6–8.2; p< 0.0001). More patients with insurance changes required one PA (59% vs 48%) or multiple PAs (27% vs 6.2%) when compared to those without changes. Of the 122 patients with an insurance change, 16 (13.1%) experienced a total of 17 insurance related medication changes (e.g., biosimilar or formulation change, medication change, patient assistance, dose escalation denial); 15 of which were directly related to the insurance change. Only 24 (3.2%) of the 761 patients without an insurance change experienced an insurance related change in therapy. Three patients discontinued medication because of an insurance change. No patients discontinued because of insurance in those without a change.

Conclusions: : Insurance changes impacted more than one in eight patients with IBD established on specialty therapy, increased PA burden, and led to more medication changes.

Sponsorship:: None.