Introduction: This analysis provides gastroenterologists’ opinions related to their treatment success with anti-tumor necrosis factor (anti-TNF) therapy in ulcerative colitis (UC) and how commercial health insurance coverage may be limiting physicians’ ability to utilize other, American College of Gastroenterology (ACG) guideline-approved treatment options, such as vedolizumab.
Methods: In April 2021, an online survey study of 102 gastroenterologists was conducted. Gastroenterologists were recruited from Spherix Global Insight’s existing US panel of respondents who participate in survey research related to several gastroenterology conditions. To qualify for this survey, physicians must spend most their time in clinical practice, must be managing a minimum of 50 UC patients per year, and must be in practice for at least 2 and no more than 40 years. The data were analyzed in SPSS.
Results: Gastroenterologists estimated that one-quarter (27%) of their UC patients treated with anti-TNF therapy experience a failed initial response to this type of treatment. Physicians also estimated that one-quarter (24%) of their UC patients treated with anti-TNF therapy develop a secondary loss of response at some point in the future.
Despite this level of performance, a significant majority of gastroenterologists in the same survey indicated that adalimumab (88%), infliximab (77%) and infliximab biosimilar (69%) are granted first-line coverage/access by commercial health insurance plans. In contrast, only 36% of gastroenterologists reported first-line coverage/access for anti-integrin therapy, vedolizumab.
Using a five-point agreement scale, 63% of gastroenterologists agreed (4 or 5 on the scale) with the statement that insurance-mandated TNF inhibitor therapy is limiting their ability to prescribe an anti-integrin therapy for their UC patients. ACG guidelines currently state that patients with moderately to severely active UC, can be recommended an anti-integrin therapy, such as vedolizumab, for induction of remission of UC.
Discussion: Further evaluation of the appropriate coverage levels provided to TNF inhibitor relative to anti-integrin therapy is recommended.
Eric John: Spherix Global Insights – Employee.
Eric John, MS. P1585 - Health Insurance Coverage Limitations of Anti-Integrin Therapy in Ulcerative Colitis and Their Impact on Anti-Tumor Necrosis Factor (Anti-TNF) Therapy Utilization, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.