PDF(Pubmed)
Abstract：
UNASSIGNED: Prior authorizations are generally required by insurers for gastroenterologists to prescribe biologics and small-molecule drugs to treat inflammatory bowel disease (IBD). Authorization denials occur in a wide variety of clinical scenarios, including denials of standard and nonstandard medication dosing.
UNASSIGNED: We performed a national cross-sectional survey on a broad variety of specific clinical scenarios to assess experience and opinions on whether or not insurance authorization denials are in accordance with clinical expertise.
UNASSIGNED: Eighty-four gastroenterologists completed the survey. Denial experience was common for infliximab dose modifications, vedolizumab dose modifications, ustekinumab first-time therapy, and maintenance dosing. The bulk of disagreement with authorization denials involved scenarios of dose escalation and re-induction guided by both loss of clinical response and/or therapeutic drug monitoring, denial of re-authorizations of stable dosing, and use of non-anti-TNFs in specific patient populations including the elderly and patients with multiple comorbidities. Respondents unanimously agreed that insurance companies do not play an adequate role in helping patients obtain PA. Furthermore, most of the respondents agree that to decrease the burden of the PA process, peer-peer processes should be between other IBD-trained providers who understand these complex treatment strategies.
UNASSIGNED: Our cross-sectional survey highlights the degree of discordance in clinical decision-making between insurers and gastroenterologists. Further engagement between gastroenterologists and insurers is needed to foster common understanding on these discordant authorization denials in these real-world clinical IBD scenarios.
UNASSIGNED: We performed a national cross-sectional survey on a broad variety of specific clinical scenarios to assess experience and opinions on whether or not insurance authorization denials are in accordance with clinical expertise.
UNASSIGNED: Eighty-four gastroenterologists completed the survey. Denial experience was common for infliximab dose modifications, vedolizumab dose modifications, ustekinumab first-time therapy, and maintenance dosing. The bulk of disagreement with authorization denials involved scenarios of dose escalation and re-induction guided by both loss of clinical response and/or therapeutic drug monitoring, denial of re-authorizations of stable dosing, and use of non-anti-TNFs in specific patient populations including the elderly and patients with multiple comorbidities. Respondents unanimously agreed that insurance companies do not play an adequate role in helping patients obtain PA. Furthermore, most of the respondents agree that to decrease the burden of the PA process, peer-peer processes should be between other IBD-trained providers who understand these complex treatment strategies.
UNASSIGNED: Our cross-sectional survey highlights the degree of discordance in clinical decision-making between insurers and gastroenterologists. Further engagement between gastroenterologists and insurers is needed to foster common understanding on these discordant authorization denials in these real-world clinical IBD scenarios.
摘要：
保险公司通常需要事先获得授权，以便胃肠病学家开出治疗炎症性肠病（IBD）的生物制剂和小分子药物。授权拒绝发生在各种各样的临床场景中，包括否认标准和非标准药物剂量。
■我们对各种特定的临床情景进行了全国性的横断面调查，以评估关于拒绝保险授权是否符合临床专业知识的经验和意见。
■84名胃肠病学家完成了这项调查。否认经验对于英夫利昔单抗剂量修改很常见，维多珠单抗剂量调整，ustekinumab首次治疗，和维持剂量。与授权拒绝的大部分分歧涉及在临床反应丧失和/或治疗药物监测的指导下剂量递增和重新诱导的情况。拒绝重新授权稳定给药，以及在包括老年人和有多种合并症的患者在内的特定患者人群中使用非抗TNF。受访者一致认为，保险公司在帮助患者获得PA方面没有发挥足够的作用。此外，大多数受访者同意，为了减轻巴勒斯坦权力机构进程的负担，对等过程应该在其他IBD培训的提供者之间进行，他们了解这些复杂的治疗策略。
■我们的横断面调查强调了保险公司和胃肠病学家在临床决策中的不一致程度。需要胃肠病学家和保险公司之间的进一步接触，以促进对这些现实世界临床IBD场景中这些不一致的授权拒绝的共识。
■我们对各种特定的临床情景进行了全国性的横断面调查，以评估关于拒绝保险授权是否符合临床专业知识的经验和意见。
■84名胃肠病学家完成了这项调查。否认经验对于英夫利昔单抗剂量修改很常见，维多珠单抗剂量调整，ustekinumab首次治疗，和维持剂量。与授权拒绝的大部分分歧涉及在临床反应丧失和/或治疗药物监测的指导下剂量递增和重新诱导的情况。拒绝重新授权稳定给药，以及在包括老年人和有多种合并症的患者在内的特定患者人群中使用非抗TNF。受访者一致认为，保险公司在帮助患者获得PA方面没有发挥足够的作用。此外，大多数受访者同意，为了减轻巴勒斯坦权力机构进程的负担，对等过程应该在其他IBD培训的提供者之间进行，他们了解这些复杂的治疗策略。
■我们的横断面调查强调了保险公司和胃肠病学家在临床决策中的不一致程度。需要胃肠病学家和保险公司之间的进一步接触，以促进对这些现实世界临床IBD场景中这些不一致的授权拒绝的共识。
