Background: Although traditional treatment algorithms for Crohn's disease (CD) and ulcerative colitis (UC) are based on stepwise drug failure, pathways are shifting to a more individualized, risk-stratified approach. There is a perception that insurance policies may not have implemented this paradigm shift (1); particularly regarding access to vedolizumab (VDZ), an anti-α4β7 integrin antibody approved for the treatment of UC and CD. This study evaluated VDZ patient access by analyzing policy information from the Managed Markets Insight & Technology (MMIT) database (2). Methods: MMIT was chosen as a resource due to its extensive coverage of medical benefits and real-time assessments of over 5,400 plans owing to nightly updates and rapid investigation into policy changes. Using their Business Views web-based tool, 2016 coverage status for all U.S. lives was queried for VDZ by indication (UC and CD) under medical benefit and classified as Not Covered, 1 Step, 2+ Steps, and No Step; each step being number of biologic failures before access to VDZ. Unknown lives were excluded from analyses. Results: Medical benefit coverage analysis was available for 298.6 million lives. VDZ was available as a first line biologic for 168.4 million (62.7%) lives for the indication of UC, and 175.3 million (64.9%) lives for the indication of CD, and VDZ coverage after 1 biologic failure (1 step) for 61.1 million (22.7%) and 62.1 million (23.0%) lives for UC and CD, respectively. Only 11.8 million (4.4%) and 5.8 million (2.1%) lives had no medical benefit coverage of VDZ for UC and CD, respectively (Table). Conclusions: Contrary to previously published access data (1), nearly two-thirds of covered lives have access to VDZ as a first-line biologic. A disease risk-stratified integration of VDZ into treatment pathways is feasible. References: 1. Yadav A, et al. Inflamm Bowel Dis. 2017;23:853-57 2. https://www.mmitnetwork.com
