In February 2021, United Healthcare (UHC) announced an exception to its policy regarding Remicade in pediatric patients that ensures children (≥16 years of age) who are currently being treated with Remicade are allowed to remain on Remicade if that is the recommendation of the treating physician. 

The UHC amended policy reflects multi-organization advocacy efforts by NASPGHAN, AGA, ACG and ASGE.

Unfortunately,  NASPGHAN has heard from many of its members that they continue to face obstacles with receiving UHC authorization for Remicade despite the new exception, including patients who receive hospital-based infusions. NASPGHAN is also aware that the practice of non-medical or non-clinically based biologic “switching” has pervaded the payer community, including for many Medicaid managed care plans. 

To most effectively and efficiently address issues of non-medical biologic switching in IBD pediatric patients, NASPGHAN is asking its members to report issues of non-medical switching and authorization denials. By collating this information, NASPGHAN will ideally be able to best advocate for its members and their patients (for example: by identifying geographic trends).  

Please use this reporting form to share cases of non-medical switching, denials, and other payer policies that are interfering with physician-patient decision making.

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* 1. Select the issue or circumstance regarding barriers to biologic treatment for your patients.

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* 2. Which payer/insurance company is associated with the issue of denial?

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* 3. What is the city, state in which you practice?

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* 4. Please include the following information so NASPGHAN staff can follow-up with you if necessary: