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Problem: Lack of communication between patient care providers and health plan decision makers hindering optimal care for IBD patients
Solution: Bring together providers from leading IBD Centers and managed care decision makers from the plans covering the same patients with regional roundtable discussions
Stimulate discussion with presentations:
Let them talk!
Provider: So you can go back to your office and advocate for us to get that [FC testing] covered?
Payer: I will, absolutely.
A testimonial that gets to the heart of what this initiative accomplished:
I just wanted to thank you all again for doing this event. I just had a patient who had lymphocytic colitis stabilized on a therapy but changed insurances to another health plan. The re-authorization was denied since it is outside of formulary guidelines. I discussed it with a GI peer reviewer but got nowhere and this patient was now late on his infusion. Normally I would be stuck but in this case I emailed pharmacy director from the meeting who then reached out to higher ups at the health plan to whom I was able to explain the situation and extenuating circumstance and the fact that he is delayed. After starting a discussion it only took 48 hours and now he is approved and getting his drug. Being able to speak to the insurance company and have that higher level discussion made the world of a difference and was only possible since you did the roundtable meeting.
Key Input From Providers
Key Input From Payers
Jointly Provided by
This activity is supported by an independent educational grant from Takeda Pharmaceuticals U.S.A., Inc.