Briefly noted: Brad D. Constant MD, MSCS, Jeremy Adler MD, MSc, Benjamin D. Gold MD, et al. JPGN Reports. 2025;1–11. Open Access! National perspectives of barriers by insurance and pharmacy benefit managers in pediatric inflammatory bowel disease

Key findings:

• In this sample of 113 pediatric patients with IBD, 77% of initial denials for biologic therapy were ultimately approved.
• The median time to receiving medication was 18 days, with administrative time (prior authorization and appeal) requiring a median of 180 min.
• More than half (60%) of patients experienced adverse outcomes or worsened quality of life due to delays in treatment.

My take (borrowed in part from authors): “Barriers to treatment by payors, of which 77% are ultimately approved, result in substantive treatment delay, patient harm, and hospitalization.” While 18 days (or more) may not seem like a lot, it is when you know the right therapy at the outset and delays lead to suffering and worsened outcomes. In addition, the insurance companies and PBMs (pharmacy benefit managers) know that exhausting valuable physician/office staff time is a disincentive. It makes physicians determine whether it is worth the fight.

Related blog posts:

• “Denials, Dilly-dallying and Despair”
• “Commercial Insurance Isn’t in the Health Care Business. It’s in the Financial Business.”
• Mark Cuban: Disrupting American Healthcare
• The Consequences of Prior Authorizations
• What’s Changing in IBD Care: Hospitalization Rates and Authorizations
• NY Times: ‘What’s My Life Worth?’ The Big Business of Denying Medical Care
• High Rates of Denying Medical Care for Medicaid Patients Managed by Health Insurers