Insurance Companies Have Poor Adherence to Guidelines for UC, CD

Most insurance companies have yet to fully adopt current guidelines for treating patients with moderate-to-severe ulcerative colitis (UC) and Crohn’s disease (CD), according to study results presented at the 2022 American College of Gastroenterology (ACG) annual meeting in October presented March 21-26, 2022, in Charlotte, North Carolina, and virtually.

Investigators wanted to determine whether current insurance company guidelines are consistent with the latest ACG and American Gastroenterological Association (AGA) guidelines for the treatment of patients with ulcerative colitis and CD.

The study authors searched the top 50 insurance companies for publicly available policy information on the use of infliximab, adalimumab, vedolizumab, tofacitinib, and ustekinumab. They extracted data on authors, date of last revision, citation of AGA/ACG guidelines and policy requirements, as well as information on the requirement to fail conventional therapies, use of biosimilars, and use of first-line biologics. The data were compared to the 2018 ACG and 2020 AGA guidelines for UC and the 2019 ACG and 2021 AGA guidelines for MC.

Among the insurance companies, 48 ​​offered health insurance, of which 33 (72.34%) had publicly available biologics insurance policies. No authors of the guidelines were listed, and the ACG/AGA guidelines were directly cited or quoted in 70.6% of the guidelines. The policy was updated between January 1, 2016 and May 31, 2022.

Of the 34 guidelines analyzed, 58.8% matched the ACG guidelines for celiac disease versus 5.8% matched the AGA guidelines for celiac disease. Additionally, 8.8% complied with both ACG and AGA guidelines for CU. In addition, 14.7% of policies allowed first-line biologic therapy for UC and 17.7% allowed first-line biologic therapy for CD.

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“As of 2022, insurance companies, which account for nearly 80% of the market, have yet to adopt the most up-to-date guidelines for inflammatory bowel disease management,” the researchers noted.

Most insurance companies call for failure of conventional therapies such as 5-aminosalicylic acid, immunomodulators and corticosteroids, although the time required to detect therapeutic failure ranges from 7 days to 6 months.

The difference in adherence between the ACG guidelines and the AGA guidelines for CD results mainly from the different recommendations for the use of an immunomodulator versus an anti-tumor necrosis factor agent as the first-line agent and the duration of treatment with Corticosteroids to failure (short-term vs. 3-5 days). The inability to use immunomodulators concurrently with biologics was the second most common reason for non-compliance with the guidelines. First-line biologics were mainly limited to adalimumab or infliximab.

“Further work is needed to better understand the implications of these discrepancies between insurance companies and formal medical guidelines on outcomes for patients with moderate to severe UC and CD,” the researchers noted.


Anand R, Anderson K, Feuerstein JD. Poor adherence by insurance companies to ACG/AGA guidelines for the treatment of moderate to severe ulcerative colitis and Crohn’s disease. Abstract presented at: ACG 2022 Annual Meeting; October 21-26, 2022; Charlotte, NC. Summary B0414.

This article originally appeared on Gastroenterology Advisor.