P2598 - Time Is of the Essence: An Analysis of IBD Advanced Therapy Initiation in a Large Community Practice

Award: ACG APP Outstanding Research Award

Award: Presidential Poster Award

Amy Stewart, NP¹, Erica R. Cohen, MD², Kristin M. Attiogbe, NP², Jennifer Lang, NP², Jessica Gandhi, PA-C², Elizabeth Thomas, NP^2
1Capital Digestive Care, Washington, DC; ²Capital Digestive Care, Chevy Chase, MD

Introduction: Current guidelines recommend initiation of advanced therapies in patients with moderate to severe inflammatory bowel disease. The insurance approval process carries a very high administrative burden that puts strain on medical practices and affects patient outcomes. We sought to determine the factors that affected mean approval time as well as time to drug start (first dose).

Methods: We conducted a retrospective review of all new biologic starts in 2023 within a 28-provider division of a community based practice. We collected data regarding patient demographics, disease history, insurance carrier, and appeals process. We used descriptive statistics to calculate the mean number of days to insurance approval and drug start. Kaplan Meir and log rank test was used to identify differences in mean times between those requiring an insurance appeal.

Results: A total of 233 patients were included in the analysis. Eighty six percent were Caucasian and 63.4% were female. The mean time to insurance approval was 4.03 days and mean time to drug initiation was 14.17 days. Diagnosis, line of therapy, buy/bill versus specialty, age/race/sex, or commercial vs federal insurance not associated with statistically significant time to approval. Time to approval for patients who required an insurance appeal (mean 19.31 days) was significantly greater than those who did not (3.09 days), p< 0.001. Of these, the appeals were eventually approved. For infusion patients who received their medication through buy & bill, the mean approval time to first infusion was 11.65 days, while specialty pharmacy infusions had a mean of 17.56 days from approval to first infusion. Patients in the chronic care management medical home had a faster new start to drug start time (8.6 days versus 14.85.)

Discussion: Our overall approval times and drug start times are relatively fast, suggesting that having dedicated and trained prior authorization coordinators plays a role in getting patients on advanced therapy sooner, though increases overhead for our practice. Patients who required an insurance appeal had significantly longer approval times (though were eventually approved) and these unnecessary insurance requirements are delaying therapy for our IBD patients. Insurance companies requiring drug through specialty pharmacies also delay infusion start times. Participation in chronic care management home led to faster drug start time as we have dedicated clinicians involved in the process.


Disclosures:


Amy Stewart, NP¹, Erica R. Cohen, MD², Kristin M. Attiogbe, NP², Jennifer Lang, NP², Jessica Gandhi, PA-C², Elizabeth Thomas, NP². P2598 - Time Is of the Essence: An Analysis of IBD Advanced Therapy Initiation in a Large Community Practice, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.