SAN FRANCISCO—Patients with inflammatory bowel disease face an array of challenges in maintaining adherence to therapy, particularly with respect to insurance coverage, which often frustrates treat-to-target goals, according to two new studies presented at the 2025 Crohn’s and Colitis Congress that attempted to quantify adherence and barriers to care.

Insurance issues are at the forefront of these challenges, according to Ariel Jordan, MD, who presented a study examining healthcare barriers. Her team identified challenges that included waiting for approvals, lengthy phone calls to get a medication approved, or being asked to use different medications or nonoptimal doses/dose frequencies. “All these issues lead to adverse health outcomes,” said Dr. Jordan, a gastroenterology fellow at the University of Michigan, in Ann Arbor.

There were some surprising and concerning findings, Dr. Jordan said. “The financial trade-offs and the cost-saving measures patients are taking are probably the most striking,” she explained. “Patients are trying to do what they can to afford their care and afford their medications, but, unfortunately, they’re having to make really dangerous trade-offs, like not even being able to afford food or rationing medications in an inappropriate way.”

Multiple Barriers to Timely, Appropriate Care

She and her co-investigators conducted an online survey of 1,963 patients with IBD and 318 caregivers in the United States over five months in 2023. The study population was 89% white and 68% female, with 60% between 26 and 64 years of age, 98% with health insurance, and 7% in areas with concentrated poverty.

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The most common reasons for untimely care were that patients couldn’t get an appointment when needed (39%), were awaiting insurance approval (26%), were unable to reach the clinic over the phone (19%), and were too busy with work or other commitments (19%).

Medication delays were common, reported by 56.2% of patients, 29.8% of whom were denied insurance coverage of a medication or specific dose/frequency, and 24.8% of whom reported step therapy or fail-first requirements. It was common to have to wait more than two days for a prescription due to additional insurance requirements (39.1%), to have a prescribed dose frequency denied (26.1%), to experience insurance denial of medication (29.8%) and to spend more than two hours on the phone trying to achieve coverage (28.1%).

Financial trade-offs included putting off vacations or major household purchases (30.1%); increased credit card debt (21.6%); cutting back on food, clothing or other basic household needs (21.4%); taking money from retirement or college savings accounts (12.7%); and taking another job or increasing work hours (10.1%). Other measures included asking for a lower-cost medication (23.6%), delaying a prescription (22.9%), not getting a medication at all (20.6%), taking less medication (15.6%), skipping doses (15.2%) and using alternative therapies instead (11.6%).

Using Resources: Telehealth, ChatGPT and Navigators

“It is great to hear the patient voice in this data, and how they are struggling needs to be amplified. I believe it would be interesting to do spinoffs from some of [the data], such as if you have a long commute or you couldn’t make it [to an appointment], were you offered telehealth? Or when you could not get the prescription you wanted, [were you offered] a biosimilar or … a totally different class [of therapy]?” said Jonathan Moses, MD, the IBD medical director at Stanford Children’s Hospital, in California, who moderated the session. “There is a lot more to learn, but I think it’s a great start.”

Dr. Moses advised health practices to include a patient navigator to assist those with insurance challenges. Dr. Jordan noted that many practices don’t have the resources for such patient navigators but said the Crohn’s & Colitis Foundation provides templates for appeal and prior authorization letters.

Dr. Moses added that he has used ChatGPT to write appeal letters. “It’s actually been quite helpful but still requires personalization for each patient,” he said.

IBD Qorus: Treating to Target

Michelle Dong, MS-4, from Geisel School of Medicine at Dartmouth, in Hanover, N.H., presented another study at the meeting, in which she and her co-investigators evaluated 115 unique IBD patients and 196 provider requests included in the Crohn’s & Colitis Foundation’s Quality of Care IBD Qorus program. The records spanned from April 2022 to May 2023 (poster 0002).

The researchers found that 66.3% of requests for endoscopy within six months were completed within that time frame, while 22.5% took longer than six months and 11.2% were never done. For requests for endoscopy within six to 12 months, 47.1% were completed on time, 17.7% took longer than 12 months and 35.3% were never completed. Fecal calprotectin requests within six months were successfully done 62.3% of the time, while 9.4% took longer and 28.3% were not completed.

Ms. Dong highlighted the importance of team efforts to ensure patients understand the importance of treating to target. “That communication with the patients and wraparound care with all the members of your care team are really important, just to make sure that no one falls through the gap,” she said.

Victor Chedid, MD, an assistant professor of medicine at Mayo Clinic, in Rochester, N.Y., echoed that need for teamwork. He noted the importance of a multidisciplinary IBD team that works with the patient to educate them about the importance of treatment to target and reminds the physician and patient to complete treat-to-target tests.

“At Mayo, the IBD pharmacist sees all my patients and helps emphasize and educate patients on the risks of their treatments, but also about treat-to-target goals,” he said. “The pharmacist and nurses are empowered to remind me or help [with an order] and ensure the patient completes it.”

—Jim Kling

Dr. Chedid reported financial relationships with Pfizer and Takeda. Drs. Dong, Jordan and Moses reported no relevant financial disclosures.

This article is from the March 2025 print issue.