Key Takeaways: The Crohn’s Disease Patient Journey
Understanding what a patient with Crohn’s disease goes through when diagnosed and managing his or her disease was the focus of a panel discussing at the 2023 PBMI Annual National Conference held in Orlando this year.
During the panel discussion, moderated by AllianceRx Walgreens Pharmacy’s Thomas Mathews, RPh, Specialty360 therapy director for chronic inflammatory diseases, participants heard from several vantage points – including a patient, physician, specialty pharmacist, and advocacy organization – each of whom impacts the journey of a patient with Crohn’s disease.
Attendees of the session were able to walk away with a better view of the journey of a patient diagnosed and living with Crohn’s disease, and how clinical care teams and patient-advocacy groups provide services during that journey.
Some key takeaways from the panel discussion:
1. Crohn’s disease is a life-changing diagnosis.
Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes inflammation in a person’s gut. It is chronic, which means it is a lifelong condition. While Crohn’s disease has no cure, treatment can put patients in remission and help them live symptom free or with minimal symptoms.
Crohn’s disease is an autoimmune disease which means the immune system wrongly attacks healthy cells, causing inflammation in the gut. Symptoms include diarrhea, abdominal pain, fatigue, nausea, reduced appetite, weight loss, blood in your stool. It often overlaps with other chronic conditions like rheumatic and dermatologic conditions.
Treatment for Crohn’s disease can include the use of medication, clinical trials, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of the GI tract.
2. Specialty pharmacists play a key role in patient care.
AllianceRx Walgreens Pharmacy has a dedicated team of individuals knowledgeable in the chronic inflammatory disease space with an in-depth understanding of the medications to treat Crohn’s disease. The specialty pharmacy also provides the patient with many options of financial assistance, if needed. Our specialty pharmacists provide in-depth medication management – they emphasize the importance of adherence, guide patients in preventing and managing adverse effects, and monitor for worsening of symptoms, infection, and depression. The specialty pharmacists also offer disease state counseling, connect patients and caregivers to resources, explore all options to help lower costs, and are available 24/7 to provide the best possible care.
3. Patients sometimes face challenges getting on therapy.
Many barriers may contribute to delays in Crohn’s patients receiving therapy. The initial challenge is often a delay in receiving a diagnosis. Crohn’s was historically thought of as an Ashkenazi Jewish disease, but Crohn’s affects all types of people. This misconception can lead to a delay in diagnosis for people of color. In addition, delays in access to a specialist and approvals for the necessary tests may also contribute to a postponed diagnosis and treatment.
Prior authorization issues may also cause delays. Many plans require step therapy, meaning a patient must fail other therapies before advancing to the medication a provider feels is best for the patient. Providers are also finding combination therapy may be the best treatment option for some patients. Many payers will not cover combination therapy that includes two biologics, leading to appeals and further delays. Organizations such as the Global Healthy Living Foundation can assist many patients with navigating the process and healthcare system to minimize the challenges they encounter after diagnosis.
4. New therapies and research continue to find new ways to help patients.
Progress in the treatment of Crohn’s disease has advanced significantly over time, and the specialty pharmacist can help patients manage their medication therapy optimally. Most recently, Rinvoq® (upadacitinib) was approved for adults with moderately-to-severely active Crohn's disease who have had an inadequate response or intolerance to one or more TNF blockers. This gave patients an oral medication option to treat their Crohn’s disease. Entyvio® (vedolizumab), which is currently available as an intravenous infusion therapy, specifically targets inflammatory factors found in the GI tract.
Additionally, the long-awaited Humira® (adalimumab) biosimilar medications are finally reaching the marketplace. A biosimilar, or biosimilar drug, is a medicine that is very close in structure and function to a biologic medicine. While they are not generics, biosimilars offer additional, possibly more cost effective, options for patients.
The bottom line: A patient’s healthcare team, along with advocacy groups, must work together to assist patients in affording medication costs and providing the highest quality of life. That means open communication, sharing data, asking questions, and seeking solutions, together.
Panelists included:
Thomas Mathews, RPh – Specialty360 therapy director for chronic inflammatory diseases (moderator), AllianceRx Walgreens Pharmacy
Hannah Cramer – Crohn’s disease patient
Renee Baiano, PharmD, CSP – Clinical program manager, AllianceRx Walgreens Pharmacy
Steven Newmark – Director of Policy and Chief Legal Officer, Global Health Living Foundation
Jeffrey Bornstein, MD – Medical director of the Orlando Health Arnold Palmer Hospital for Children Center for Digestive Health and Nutrition