The day focused on education in the different areas derived from these conditions, such as clinical management, and strategies to guarantee access to patients.
By: Maria Camila Sanchez
February 27, 2024
Staff from the Puerto Rico Health Insurance Administration (ASES), and leading specialists in gastroenterology, met as a sign of commitment to patients with inflammatory bowel diseases (IBD), in a continuing education event organized by the Revista Medicina y Public health.
Dr. Ahmed Morales, a specialist gastroenterologist, attended the event alongside Dr. Aura Delgado, a colorectal surgeon, Héctor Hernández, PharmD, CSP Pharmacy Director; Suzette Vélez Rivera, PharmD, BCACP, BCGP and Lcda. Milagros Soto, director of clinical affairs at ASES.
New special coverage for patients with IBD
The first conversation was led by Lcda. Milagros Soto, who explained the work carried out under the Government’s health plan for patients with inflammatory bowel diseases and how this population can benefit from the implementation of the new policy focused on Crohn’s disease, ulcerative colitis, and microscopic colitis.
“Insurers, as soon as they receive all the documentation for that patient, have up to 72 hours to register the patient so that they can have access to their coverage,” she explained. To access, a “diagnostic certification from a gastroenterologist, endoscopic studies, reliable diagnostic tests or biopsy and evidence that rules out acute infectious etiology” are required.
In addition, she mentioned that once it is confirmed that the patient suffers from the condition, they have immediate access to all services through special coverage, as long as they comply with the recertification process of the Medicaid program.
Main treatment mechanisms for inflammatory bowel diseases
As part of the event, specialists met to discuss the management of inflammatory bowel diseases, from the clinical, pharmacological, surgical approach, and the access modalities available for the treatment of these conditions.
“If we are going to focus on Crohn’s disease and ulcerative colitis, we are going to say that they are the two main diseases that we treat,” said Dr. Morales. “These two conditions have a series of complications if patients are not treated properly, such as the risk of colon cancer, strictures, fistulas, abscess, among others, that potentially with the medications that exist now, versus those that existed before, they can prevent them.
Most common surgical procedures in this population
On the other hand, Dr. Delgado mentioned the most common types of surgical interventions, which usually depend on the type of disease the patient suffers from. “In patients with Crohn’s, the most common abdominal surgery is ileocolectomy, which consists of removing the terminal portion of the small intestine, and the most proximal portion of the large intestine.”
Likewise, she mentioned that those who are diagnosed with this condition and perianal disease usually develop fistulas and abscesses that require control. “Sometimes we have to make incisions and drains, long drains while the medicines take effect.”
Pharmacological management
Hector Hernandez pointed out that, when the patient and specialist reach a consensus on the treatment to follow, that prescription reaches a specialized pharmacy where the patient’s information is evaluated, such as the risks of allergy to the treatment, other medications, weight, etc.
“The prescription must include the diagnosis to know what stage of the condition the patient is in, whether the patient has used previous treatments, the clinical note and the corresponding laboratory tests.”
Strategies to ensure access to all patients
On the other hand, Suzette Vélez recognized that closing the gaps in access to treatments is a joint effort, not only on the part of the insurer and the treating specialist, but it is necessary for the patient to take a more active role in this process.
“We have a fundamental role of the medical plans, the insurer, and the pharmacy services manager, and even the manufacturer in the drugstore plays an important role to ensure access to medications,” she explained.