Bridging the Insurance Gap in Transition-Age IBD Care, With Laura Wingate

Young adulthood represents a critical and often fragile period in the care continuum for patients with chronic disease, including inflammatory bowel disease (IBD). As patients transition from pediatric to adult care, they face increased risks of disease activity, treatment disruption, and healthcare utilization, while simultaneously assuming responsibility for insurance coverage and care navigation for the first time.

Emerging data from the Crohn’s & Colitis Foundation suggest that this transition is further complicated by disproportionate insurance barriers and financial strain, raising concerns about access to timely, appropriate treatment and the long-term consequences for disease control and health outcomes.

The 52-question electronic, US-based survey included questions on medication access, experience with step therapy mandates, financial barriers to obtaining medications, and disease and demographic characteristics.

Results showed young adults 18-25 years of age were significantly more likely to experience insurance-mandated step therapy, with 35% reporting these requirements in the past 12 months compared to 27% of adults and 20% of pediatric caregivers.​ Additionally, 35% of young adults reported low confidence in knowing which questions to ask their insurer during coverage issues, versus 25% of pediatric caregivers indicating greater uncertainty and need for support among young adults.​

Of note, 18% of young adult patients reported taking on extra jobs or increased work hours to cover healthcare or insurance costs for their IBD, a significantly higher rate than both adults (11%) and pediatric caregivers (11%).​

“One key message for healthcare providers is to frame insurance navigation as a fundamental part of transition competency,” Laura Wingate, Chief Education, Support & Advocacy Officer at the Crohn's & Colitis Foundation, told HCPLive. “This is really on par with medication self-management and building their medications into their adult routines, clearly identifying a team member, such as a nurse, a navigator, a social worker that can be the point person for insurance related issues, and coordinating that handoff from pediatric care, where so much of this is handled for the young person by the their parents and the healthcare system.”

Wingate also underscored the importance of proactively assessing skills that may not yet be fully developed in this population, including financial understanding and health literacy. By incorporating targeted questions into clinic visits, healthcare teams can flag young adults who may be at higher risk for insurance-related barriers before delays or denials disrupt care, and practices can connect these patients with internal resources or external support, such as educational tools designed specifically for young adults navigating insurance.

“It really is about all of us working together, and clinicians can contribute practice-based data on delays, denials, the outcomes that they're seeing that are negatively impacting young people, and use this evidence to inform research questions that then can help set policy priorities that are focused on young adults with IBD,” Wingate said. “Researchers can then further dissect this information and work with insurance practices to address this and also address those transition gaps so that we begin to create more of a smooth process for young people transitioning care.”

She notes that advocacy organizations can additionally leverage this evidence to push for reforms focused on utilization management practices, improved insurer transparency, and better coordination of care for young adults with IBD. Taken together, these efforts have the potential to help move the field beyond describing access barriers toward implementing concrete changes that improve care continuity and outcomes during this vulnerable stage.

References

1. Brooks A. Young Adults With IBD Face Greater Healthcare Access Challenges, Financial Burdens. HCPLive. January 6, 2026. Accessed January 9, 2026. https://www.hcplive.com/view/young-adults-with-ibd-face-greater-healthcare-access-challenges-financial-burdens

2. Crohn's & Colitis Foundation. Crohn's & Colitis Foundation survey reveals more than 1/3 of young adults with IBD face step therapy insurance barriers. January 6, 2026. Accessed January 9, 2026. https://www.eurekalert.org/news-releases/1111249