Category: Worksheets
Utilization management hurdles

Inflammatory bowel diseases (IBD) affect about 3 million Americans, with peak onset between ages 15 and 30.1 Evidence shows that early biologic therapy for moderate-to-severe IBD leads to faster, higher remission rates, reducing hospitalizations and surgeries.2 This has shifted the treatment paradigm from the traditional “step-up” approach to early biologic initiation, now reflected in clinical guidelines for ulcerative colitis and Crohn’s disease.3,4 Despite advances in care, significant barriers to treatment remain, largely driven by health insurance policies and market-driven health care decisions.
Repeated, frequent prior authorization requests

Guidance for managing stable patients responding to treatment, reauthorization requirements for continuing the same therapy, and variation in payor timelines
for reauthorization.
Non-medical switching

Non-medical switching refers to changing a patient’s medication for reasons unrelated to clinical efficacy, safety, or patient preferences often driven by payors, pharmacy benefit managers (PBMs), specialty pharmacies, or health system.
Dose and/or frequency limitations

Guidance for managing stable patients responding to treatment, reauthorization requirements for continuing the same therapy, and variation in payer timelines for reauthorization.
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