Higher Rates of Delay in Starting Advanced Inflammatory Bowel Disease Therapies Linked to Insurance Delays, Intravenous Infusions, and Lack of Pharmacy Support

Abstract

INTRODUCTION:Because biologic and small molecule therapy is expensive, payors have mandated preauthorizations for these medications, often resulting in a lengthy approval process. The aims of this study were to assess the frequency of and risk factors for delays in starting advanced therapies assessing insurance, care team, and patient-related factors.METHODS:Retrospective, multicenter study of patients with adult inflammatory bowel disease with prescriptions for an advanced therapy in 2 geographically distinct academic gastroenterology practices: one with and the other without a dedicated pharmacist. A priori, we defined a delay in starting therapy as >14 days between prescription and the first dose. Logistic regression analysis was performed to assess for risk factors for delay.RESULTS:A total of 388 patients were prescribed advanced therapies with 46.6% receiving their first dose within 14 days. Patients who were on time vs delayed were similar in baseline demographics, disease characteristics, and disease activity. After adjusting for confounders, 3 independent risk factors remained significant as predictors for delay: study site (OR = 5.2, 95% CI 2.894, 9.333), intravenous drug delivery as opposed to subcutaneous or oral (OR = 3.07, 95% CI 1.845, 5.099), and insurance denial (OR = 2.72, 95% CI 1.082, 6.825).DISCUSSION:In a multicenter study, we found that a delay between prescription and administration of the first dose of an advanced therapy is common, with > 50% of patients having the first dose delayed by > 2 weeks. Delays in starting therapy were significantly more likely if denied by insurance, given by intravenously induction, or at a study site without a dedicated pharmacist.