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保险公司对中度至重度性结肠炎/克罗恩病管理指南的不充分遵守
Kelsey L Anderson1, Rajsavi Anand2, Joseph D Feuerstein3
1Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.
对于炎症性肠病 (IBD) 的生物疗法,保险覆盖是有限的,往往需要先前的治疗失败. 这限制了患者获得克罗恩病和性结肠炎指南建议的护理.
科学领域:
- 胃肠病学 胃肠病学
- 医疗保险政策 医疗保险政策
背景情况:
- 生物药物代表了治疗中度至重度炎症性肠病 (IBD) 的转变,从一步升级到缓解诱导疗法.
- 对于许多患者来说,这些先进治疗的保险覆盖仍然是一个重要的障碍.
研究的目的:
- 评估用于IBD治疗的生物和小分子药物的保险政策.
- 将保险公司的要求与美国胃肠病学学院 (ACG) 和美国胃肠病学协会 (AGA) 的既定临床指南进行比较.
主要方法:
- 对50家顶级保险公司公开可用的保单的分析.
- 专注于五个关键生物/小分子剂的覆盖标准.
- 与ACG/AGA指南相比,对政策要求的比较评估.
主要成果:
- 只有34家保险公司提供了公共政策进行审查.
- 遵守ACG/AGA指南的比例差异很大,从5.8%到58.8%.
- 很少有政策允许一线生物治疗:克罗恩病的14.71%,性结肠炎的17.65%.
结论:
- 大多数保险公司在批准生物治疗之前强制要求传统疗法 (类固醇,免疫调节剂) 失败.
- 目前的保险实践阻碍了患者获得指南推的IBD标准护理治疗.
- 需要进一步的宣传和政策变化,以改善患者获得必不可少的IBD疗法.
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